Provider Demographics
NPI:1922486653
Name:DAVIS, MEGAN DALY (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:DALY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ALYSSA
Other - Last Name:DALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:5356 STADIUM TRACE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-5607
Mailing Address - Country:US
Mailing Address - Phone:205-985-9424
Mailing Address - Fax:205-985-9465
Practice Address - Street 1:5356 STADIUM TRACE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-5607
Practice Address - Country:US
Practice Address - Phone:205-985-9424
Practice Address - Fax:205-985-9465
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-137131363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL182583Medicaid