Provider Demographics
NPI:1245678598
Name:DAVIS, ANGELA C (NP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26194
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2012
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:833-908-0998
Practice Address - Street 1:1018 HIGHWAY 321 N
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-6683
Practice Address - Country:US
Practice Address - Phone:865-986-4450
Practice Address - Fax:833-908-2124
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1531991Medicaid
TN0677340001Medicare NSC
TN1531991Medicaid
TN10350I5171Medicare PIN
TN103I505170Medicare PIN
TN10350I5169Medicare PIN
TN0677340004Medicare NSC
TN0677340002Medicare NSC
TN103I505172Medicare PIN
TN103I505167Medicare PIN
TN0677340008Medicare NSC