Provider Demographics
NPI:1740219005
Name:DAVIDSON, NETTIE NICHOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:NETTIE
Middle Name:NICHOLE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5801 OAKBEND TRL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3912
Mailing Address - Country:US
Mailing Address - Phone:817-294-9000
Mailing Address - Fax:817-294-9010
Practice Address - Street 1:5801 OAKBEND TRL
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3912
Practice Address - Country:US
Practice Address - Phone:817-294-9000
Practice Address - Fax:817-294-9010
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9672207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170397701Medicaid
TX8G4626OtherBCBS
TX170397701Medicaid
TXI23869Medicare UPIN
TXP00245200Medicare PIN