Provider Demographics
NPI:1528202249
Name:DAVIS, ROLANDA J (FNP PMHNP)
Entity Type:Individual
Prefix:
First Name:ROLANDA
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N PECAN ST STE A
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:74048-2638
Mailing Address - Country:US
Mailing Address - Phone:191-832-7025
Mailing Address - Fax:
Practice Address - Street 1:406 N PECAN ST STE A
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048-2638
Practice Address - Country:US
Practice Address - Phone:918-327-0254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK95063363LP0808X, 363LF0000X, 363LP0808X
TXAP136864363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology