Provider Demographics
NPI:1295113728
Name:DAVIS FAMILY CARE, LLC
Entity type:Organization
Organization Name:DAVIS FAMILY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/APN
Authorized Official - Prefix:
Authorized Official - First Name:FAYTHE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:816-233-7258
Mailing Address - Street 1:1335 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2457
Mailing Address - Country:US
Mailing Address - Phone:816-233-7258
Mailing Address - Fax:
Practice Address - Street 1:1335 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2457
Practice Address - Country:US
Practice Address - Phone:816-233-7258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-17
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014005307363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty