Provider Demographics
NPI:1639739980
Name:DAVIS, SUSAN JEAN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 SOUTH IH 35
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-9426
Mailing Address - Country:US
Mailing Address - Phone:254-939-2100
Mailing Address - Fax:254-939-2334
Practice Address - Street 1:3500 SOUTH IH 35
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-9426
Practice Address - Country:US
Practice Address - Phone:254-939-2100
Practice Address - Fax:254-939-2334
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140923363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health