1598593840 NPI number — MRS. VANESSA LAVERNE DAVIS MHS

Table of content: MRS. VANESSA LAVERNE DAVIS MHS (NPI 1598593840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598593840 NPI number — MRS. VANESSA LAVERNE DAVIS MHS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
VANESSA
Provider Middle Name:
LAVERNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MHS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598593840
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2620 CENTENARY BLVD STE 312
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71104-3358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-681-9935
Provider Business Mailing Address Fax Number:
318-681-9938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5612 CASMERE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71129-4018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-288-8982
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/26/2024

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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