Provider Demographics
NPI:1396136693
Name:DAVIS, GRANT LANDON (APRN)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:LANDON
Last Name:DAVIS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 N CENTRAL EXPY STE 235
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2047
Mailing Address - Country:US
Mailing Address - Phone:214-785-5547
Mailing Address - Fax:214-329-0553
Practice Address - Street 1:2929 N CENTRAL EXPY STE 235
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2047
Practice Address - Country:US
Practice Address - Phone:214-785-5547
Practice Address - Fax:214-329-0553
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127536363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX756930OtherLICENSE