1477585230 NPI number — REBECCA F DAVIS APRN, CNM

Table of content: REBECCA F DAVIS APRN, CNM (NPI 1477585230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477585230 NPI number — REBECCA F DAVIS APRN, CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
REBECCA
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLORES
Provider Other First Name:
REBECCA
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477585230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1158
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABBEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70511-1158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-892-0630
Provider Business Mailing Address Fax Number:
337-893-0403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 ALLENDALE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ALLEN
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70767-3219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-389-1311
Provider Business Practice Location Address Fax Number:
225-389-1330
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  AP03087 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1696846 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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