Provider Demographics
NPI:1295599363
Name:DAVIS, SHENANDOAH (AGNP-C)
Entity type:Individual
Prefix:
First Name:SHENANDOAH
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:MRS
Other - First Name:SHENANDOAH
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, AGNP-C
Mailing Address - Street 1:1615 MCALLEN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75654-4273
Mailing Address - Country:US
Mailing Address - Phone:903-658-6398
Mailing Address - Fax:
Practice Address - Street 1:1615 MCALLEN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75654-4273
Practice Address - Country:US
Practice Address - Phone:903-658-6398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1152445363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology