Provider Demographics
NPI:1770840092
Name:DAVIS, ANDRIANA RENEE (MHPP)
Entity Type:Individual
Prefix:
First Name:ANDRIANA
Middle Name:RENEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 BOB COURTWAY DR STE 9
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4767
Mailing Address - Country:US
Mailing Address - Phone:501-328-5525
Mailing Address - Fax:501-328-5342
Practice Address - Street 1:1100 BOB COURTWAY DR STE 9
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4767
Practice Address - Country:US
Practice Address - Phone:501-328-5525
Practice Address - Fax:501-328-5342
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator