Provider Demographics
NPI:1780182311
Name:DAVIS, MICHELLE LYNN (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3799 12TH STREET EXT STE 110
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-3750
Mailing Address - Country:US
Mailing Address - Phone:803-755-3337
Mailing Address - Fax:
Practice Address - Street 1:501 BLYTHEWOOD RD
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-9535
Practice Address - Country:US
Practice Address - Phone:803-673-1971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily