Provider Demographics
NPI:1881796548
Name:DAVIS, MICHELE MACKIE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:MACKIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MICHELE
Other - Last Name:MACKIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:SPEARMAN
Mailing Address - State:TX
Mailing Address - Zip Code:79081-0693
Mailing Address - Country:US
Mailing Address - Phone:806-886-3226
Mailing Address - Fax:
Practice Address - Street 1:2000 ESTERS RD
Practice Address - Street 2:STE 140
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-9531
Practice Address - Country:US
Practice Address - Phone:469-212-1399
Practice Address - Fax:469-212-1399
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA 04511363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant