Provider Demographics
NPI:1881951994
Name:DAVIS, MICHELLE L (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-1181
Mailing Address - Country:US
Mailing Address - Phone:865-213-8590
Mailing Address - Fax:865-213-8596
Practice Address - Street 1:304 WRIGHT STREET
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-2823
Practice Address - Country:US
Practice Address - Phone:865-213-8590
Practice Address - Fax:865-213-8596
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN16622363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0921780OtherBLUE CROSS BLUE SHIELD
TNQ000332Medicaid
TNQ000332Medicaid