Provider Demographics
NPI:1356107569
Name:DAVIS, ANGELO C III (DNP, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:C
Last Name:DAVIS
Suffix:III
Gender:M
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 S 34TH ST APT 307
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4796
Mailing Address - Country:US
Mailing Address - Phone:206-999-6260
Mailing Address - Fax:
Practice Address - Street 1:8550 CUTHILLS CIR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9474
Practice Address - Country:US
Practice Address - Phone:402-476-6060
Practice Address - Fax:402-476-6809
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE115041363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health