Provider Demographics
NPI:1740882828
Name:DAVIS, SABRINA L (PMHNP)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-
Mailing Address - Street 1:PO BOX 11545
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-0345
Mailing Address - Country:US
Mailing Address - Phone:314-323-7116
Mailing Address - Fax:
Practice Address - Street 1:1033 WHITTIER ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-3135
Practice Address - Country:US
Practice Address - Phone:314-323-7116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020037225363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health