Doctor Name: | PAMELA G DAVIS |
NPI Number: | 1780907238 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 14820 |
Business Practice Address: | 281 Paradise Ln Jacksboro, TN - 377573931 |
Business Phone Number: | 8656793306 |
Business Fax Number: | |
Mailing Address: | 281 Paradise Ln, JACKSBORO |
State: | TN |
Postal Code: | 377573931 |
Phone Number: | 8656793306 |
Fax Number: | |
NPI Enumeration Date: | 03/11/2010 |
NPI Last Update Date: | 02/15/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 14820 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |