Provider Demographics
NPI:1841226743
Name:DAVIS, JUDY LANE (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:LANE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 S MIDLOTHIAN PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5591
Mailing Address - Country:US
Mailing Address - Phone:972-723-1474
Mailing Address - Fax:972-723-9423
Practice Address - Street 1:1441 S MIDLOTHIAN PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5591
Practice Address - Country:US
Practice Address - Phone:972-723-1474
Practice Address - Fax:972-723-9423
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX532422363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155009703Medicaid
TX1550097-01Medicaid
TX8F3659Medicare PIN
TX1550097-01Medicaid
TX155009703Medicaid
TXP49943Medicare UPIN
TX500025651Medicare PIN