Provider Demographics
NPI:1477585230
Name:DAVIS, REBECCA F (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:F
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1158
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70511-1158
Mailing Address - Country:US
Mailing Address - Phone:337-892-0630
Mailing Address - Fax:337-893-0403
Practice Address - Street 1:203 ALLENDALE DR
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-3219
Practice Address - Country:US
Practice Address - Phone:225-389-1311
Practice Address - Fax:225-389-1330
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03087367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1696846Medicaid
5X263DD21Medicare PIN
LA5X263Medicare ID - Type UnspecifiedMEDICARE #