Provider Demographics
NPI:1578543997
Name:DAVIS, DONNA KAY (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:KAY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-1267
Mailing Address - Country:US
Mailing Address - Phone:336-786-4522
Mailing Address - Fax:336-786-3752
Practice Address - Street 1:110 DUTCHMAN CT
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2237
Practice Address - Country:US
Practice Address - Phone:336-835-5330
Practice Address - Fax:336-835-5337
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61706363L00000X
NC201053363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS66375Medicare UPIN
NC2598008BMedicare ID - Type Unspecified