Provider Demographics
NPI:1740430560
Name:DAVIS, MARLENE MICHELLE (APN)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:MICHELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:MICHELLE
Other - Last Name:LADD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22310 COL GLENN RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-5332
Mailing Address - Country:US
Mailing Address - Phone:501-821-3137
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR20481163WE0003X
ARA03153 APN363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WE0003XNursing Service ProvidersRegistered NurseEmergency