Provider Demographics
NPI:1679980148
Name:DAVIS, CINNAMON RENIQUE (APRN, PMHNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:CINNAMON
Middle Name:RENIQUE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN, PMHNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 ALLEN TOUSSAINT BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-2146
Mailing Address - Country:US
Mailing Address - Phone:504-842-4025
Mailing Address - Fax:
Practice Address - Street 1:1532 ALLEN TOUSSAINT BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-2146
Practice Address - Country:US
Practice Address - Phone:504-842-4025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07885363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07682721Medicaid
LA2381245Medicaid
LA371888ZF3LMedicare PIN
LA371888YH3UMedicare PIN