Provider Demographics
NPI:1881918084
Name:DAVIS, NATAUSHA PATRICE
Entity type:Individual
Prefix:
First Name:NATAUSHA
Middle Name:PATRICE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9516 S SHIELDS BLVD APT 233
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-3126
Mailing Address - Country:US
Mailing Address - Phone:405-306-8429
Mailing Address - Fax:
Practice Address - Street 1:9516 S SHIELDS BLVD APT 233
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3126
Practice Address - Country:US
Practice Address - Phone:405-306-8429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200123000AMedicaid