Provider Demographics
NPI:1952582082
Name:DAVIS, NATASHA NICOLE (SLP)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:NICOLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N MISSOURI ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-3148
Mailing Address - Country:US
Mailing Address - Phone:870-400-0179
Mailing Address - Fax:870-400-0479
Practice Address - Street 1:100 N HUMPHREYS BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2146
Practice Address - Country:US
Practice Address - Phone:901-747-1800
Practice Address - Fax:901-747-1801
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2929235Z00000X
TN4707235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARSP#2929OtherSPEECH THERAPY