Provider Demographics
NPI:1265147003
Name:DAVIS, NINA SIMONE (APRN PMHP-BC)
Entity type:Individual
Prefix:MISS
First Name:NINA
Middle Name:SIMONE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN PMHP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1391 KILDAIRE FARM RD # 1080
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5525
Mailing Address - Country:US
Mailing Address - Phone:202-352-1341
Mailing Address - Fax:
Practice Address - Street 1:4250 CLINTON RD STE 102
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28312-8517
Practice Address - Country:US
Practice Address - Phone:910-920-1050
Practice Address - Fax:910-920-1051
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC155605163WA0400X
MI4704206128163WA2000X
DCRN1008379163WC0200X, 163WP0000X
TX155605251B00000X
NC5018787363LG0600X, 363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No251B00000XAgenciesCase Management
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health