Provider Demographics
NPI:1558501411
Name:DAVIS, SALLY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 N WARREN ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3454
Mailing Address - Country:US
Mailing Address - Phone:406-443-2189
Mailing Address - Fax:
Practice Address - Street 1:3687 VETERANS DRIVE
Practice Address - Street 2:FORT HARRISON
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59636
Practice Address - Country:US
Practice Address - Phone:406-447-7564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT434363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical