Provider Demographics
NPI:1740396712
Name:DAVIS, NANCY J (FNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HERITAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-4865
Mailing Address - Country:US
Mailing Address - Phone:903-892-2133
Mailing Address - Fax:903-893-6317
Practice Address - Street 1:1000 HERITAGE PKWY
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-4865
Practice Address - Country:US
Practice Address - Phone:903-892-2133
Practice Address - Fax:903-893-6317
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX533641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N8981OtherBLUE CROSS BLUE SHIELD
TX8N8981OtherBLUE CROSS BLUE SHIELD
P42482Medicare UPIN
TXTXB161886Medicare PIN
TXTXB161889Medicare PIN
TX8G0251Medicare ID - Type Unspecified