Provider Demographics
NPI:1881885895
Name:REEL DAVIS, CHANEY (RN, PMHNP, FNP)
Entity type:Individual
Prefix:
First Name:CHANEY
Middle Name:
Last Name:REEL DAVIS
Suffix:
Gender:F
Credentials:RN, PMHNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5331 S MACADAM AVE STE 258 PMB 1032
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3871
Mailing Address - Country:US
Mailing Address - Phone:503-847-9055
Mailing Address - Fax:503-847-9056
Practice Address - Street 1:5305 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5324
Practice Address - Country:US
Practice Address - Phone:503-847-9055
Practice Address - Fax:503-847-9056
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201050179NP363LP0808X
OR200843072RN163W00000X
OR2011017245363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily