Provider Demographics
NPI:1992037790
Name:DAVIDSON, STACY LAYTON (FNP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LAYTON
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 W HWY 89A
Mailing Address - Street 2:SUITE B1
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5256
Mailing Address - Country:US
Mailing Address - Phone:928-254-3676
Mailing Address - Fax:928-208-4900
Practice Address - Street 1:2530 W HWY 89A
Practice Address - Street 2:SUITE B1
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5256
Practice Address - Country:US
Practice Address - Phone:928-254-3676
Practice Address - Fax:928-208-4900
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily