Provider Demographics
NPI:1669746467
Name:STACY L. DAVIDSON, FNP-BC PC
Entity type:Organization
Organization Name:STACY L. DAVIDSON, FNP-BC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LAYTON
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:928-301-6144
Mailing Address - Street 1:2155 SHELBY DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5476
Mailing Address - Country:US
Mailing Address - Phone:928-254-3676
Mailing Address - Fax:
Practice Address - Street 1:2155 SHELBY DR
Practice Address - Street 2:SUITE C
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5476
Practice Address - Country:US
Practice Address - Phone:928-254-3676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty