Provider Demographics
NPI:1740614015
Name:DAVIS, LAUREN LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LEIGH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MARILLYN DR
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-7258
Mailing Address - Country:US
Mailing Address - Phone:082-536-0200
Mailing Address - Fax:
Practice Address - Street 1:123 S 27TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-4227
Practice Address - Country:US
Practice Address - Phone:406-247-3350
Practice Address - Fax:406-247-3389
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2023-01-25
Deactivation Date:2019-04-15
Deactivation Code:
Reactivation Date:2019-04-17
Provider Licenses
StateLicense IDTaxonomies
MTMED-PAC-LIC-87256207Q00000X
363A00000X
MT87256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine