1831345883 NPI number — ALEXA DALE DAVIS PHD

Table of content: ALEXA DALE DAVIS PHD (NPI 1831345883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831345883 NPI number — ALEXA DALE DAVIS PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
ALEXA
Provider Middle Name:
DALE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
DALE
Provider Other Middle Name:
DAVIS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831345883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4253 N CROSSOVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72703-4593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-521-5731
Provider Business Mailing Address Fax Number:
479-521-6520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
702 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
HARRISON
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72601-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-741-2658
Provider Business Practice Location Address Fax Number:
870-741-2722
Provider Enumeration Date:
08/11/2008

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: 103T00000X , with the licence number:  08-11P , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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