Provider Demographics
NPI:1558334037
Name:DAVIS, BARBARA J (PA-C)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8906 SPANISH RIDGE AVE
Mailing Address - Street 2:#202
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1304
Mailing Address - Country:US
Mailing Address - Phone:702-577-1622
Mailing Address - Fax:702-912-4994
Practice Address - Street 1:6080 S FORT APACHE RD
Practice Address - Street 2:#110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5656
Practice Address - Country:US
Practice Address - Phone:702-871-0303
Practice Address - Fax:702-562-0054
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPAC116363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00054851OtherRAILROAD MEDICARE
NV2402254Medicaid
R68634Medicare UPIN
NVP00054851OtherRAILROAD MEDICARE