Provider Demographics
NPI:1134356553
Name:DAVIS, CRESHA TANARA-TULANI (MD)
Entity type:Individual
Prefix:
First Name:CRESHA
Middle Name:TANARA-TULANI
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5332
Mailing Address - Country:US
Mailing Address - Phone:318-807-4611
Mailing Address - Fax:318-807-4615
Practice Address - Street 1:122 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5332
Practice Address - Country:US
Practice Address - Phone:318-807-4611
Practice Address - Fax:318-807-4615
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2082182084S0012X, 2084N0400X
MI4301099354208000000X, 2084N0402X
LAMD2082182084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1134356553Medicaid