Provider Demographics
NPI:1720577562
Name:DAVIS, ERIN ELLIS (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:ELLIS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045
Mailing Address - Country:US
Mailing Address - Phone:205-755-3980
Mailing Address - Fax:205-755-0119
Practice Address - Street 1:107 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045
Practice Address - Country:US
Practice Address - Phone:205-755-3980
Practice Address - Fax:205-755-0119
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-130320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily