| Doctor Name: | PETISHA DAVIS |
| NPI Number: | 1134589542 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 14106475111 |
| Business Practice Address: | 1700 Rainbow Blvd Excelsior Springs, MO - 640241182 |
| Business Phone Number: | 8166306081 |
| Business Fax Number: | 8166293661 |
| Mailing Address: | 14951 M Highway, RAYVILLE |
| State: | MO |
| Postal Code: | 640849074 |
| Phone Number: | 8168076228 |
| Fax Number: | |
| NPI Enumeration Date: | 02/26/2016 |
| NPI Last Update Date: | 04/12/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 14106475111 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |