Provider Demographics
NPI:1881734440
Name:DAVI, TIMOTHY J (FNP)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:J
Last Name:DAVI
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 E CHEROKEE ST
Mailing Address - Street 2:ATTN: MERCY SLEEP CENTER
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2203
Mailing Address - Country:US
Mailing Address - Phone:417-820-5467
Mailing Address - Fax:417-820-5465
Practice Address - Street 1:1235 E CHEROKEE ST
Practice Address - Street 2:ATTN: MERCY SLEEP CENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2203
Practice Address - Country:US
Practice Address - Phone:417-820-5467
Practice Address - Fax:417-820-5465
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO142912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425179405Medicaid
MO82456OtherAR BLUE SHIELD #
MOP16755Medicare UPIN
MO425179405Medicaid
MO183013230Medicare PIN