Provider Demographics
NPI:1982194320
Name:DAVIS, HENRY EDWARD JR (APRN FNP)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:EDWARD
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:APRN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 N CLASSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2431
Mailing Address - Country:US
Mailing Address - Phone:405-320-9431
Mailing Address - Fax:
Practice Address - Street 1:4215 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2431
Practice Address - Country:US
Practice Address - Phone:405-320-9431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57710363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200811100AMedicaid