Provider Demographics
NPI:1982369716
Name:DAVIS, DEANNA L (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 NW MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-4079
Mailing Address - Country:US
Mailing Address - Phone:972-875-9377
Mailing Address - Fax:972-875-4325
Practice Address - Street 1:109 NW MAIN ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4079
Practice Address - Country:US
Practice Address - Phone:972-875-9377
Practice Address - Fax:972-875-4325
Is Sole Proprietor?:No
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058077363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily