Provider Demographics
NPI:1457780306
Name:DAVIS, DEBBIE LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 N MILLER RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-1043
Mailing Address - Country:US
Mailing Address - Phone:623-386-5785
Mailing Address - Fax:623-386-6673
Practice Address - Street 1:1209 N MILLER RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-1043
Practice Address - Country:US
Practice Address - Phone:623-386-5785
Practice Address - Fax:623-386-6673
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ981435Medicaid
AZZ173909Medicare UPIN