Provider Demographics
NPI:1770827867
Name:DAVIS, DANA NICHOLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:NICHOLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:DANA
Other - Middle Name:NICHOLE
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1900 EXETER RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2954
Mailing Address - Country:US
Mailing Address - Phone:662-315-0843
Mailing Address - Fax:901-682-9522
Practice Address - Street 1:1900 EXETER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2954
Practice Address - Country:US
Practice Address - Phone:662-315-0843
Practice Address - Fax:901-682-9522
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN175063163W00000X, 367500000X
MS90893367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN12518435Medicaid
TN1770827867OtherTRICARE/HUMANA/CHAMPUS
AR196343001Medicaid
TN4342060OtherBLUE CROSS OF TN
TN12518435Medicaid