Provider Demographics
NPI:1629617097
Name:DAVIS, CAROLYN YVONNE (PNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:YVONNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:YVONNE
Other - Last Name:HINSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:1305 WEST MAIN STREET
Mailing Address - City:PLEASANT LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46779-0007
Mailing Address - Country:US
Mailing Address - Phone:210-602-6640
Mailing Address - Fax:260-664-2452
Practice Address - Street 1:909B SOUTH DARLING STREET
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703
Practice Address - Country:US
Practice Address - Phone:260-665-3146
Practice Address - Fax:260-664-2452
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28047285A163WP0200X
TXAP109792363LP0200X
IN71009581A363LP0200X
TX575639163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics