Provider Demographics
NPI:1811425937
Name:DAVIES, DAWN R (PMHNP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:DAVIES
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3559
Mailing Address - Country:US
Mailing Address - Phone:607-245-9308
Mailing Address - Fax:
Practice Address - Street 1:2521 E 15TH ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4126
Practice Address - Country:US
Practice Address - Phone:307-237-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA147339163W00000X
NY571270163W00000X
IAG147339363LP0808X
WY54461363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0076372Medicaid