Provider Demographics
NPI:1477825099
Name:DAVIS, SHANEDRA RACHELLE (NP)
Entity Type:Individual
Prefix:MS
First Name:SHANEDRA
Middle Name:RACHELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 ASHLYN ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-2152
Mailing Address - Country:US
Mailing Address - Phone:281-793-0437
Mailing Address - Fax:
Practice Address - Street 1:485 RAINIER AVE S STE B
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2428
Practice Address - Country:US
Practice Address - Phone:281-793-0437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX792827163W00000X
TXAP139333363LF0000X
WAAP61139752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse