Provider Demographics
NPI:1568950822
Name:DAVIS, JOSEPH W (LVN)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:W
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:2731 WORRELL AVE
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-1237
Mailing Address - Country:US
Mailing Address - Phone:806-662-2837
Mailing Address - Fax:
Practice Address - Street 1:2731 WORRELL AVE
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-1237
Practice Address - Country:US
Practice Address - Phone:806-662-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX301212164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse