Clinton Davis, APRN, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

28302 Issued in TN

Practice address

1025 Executive Park Blvd
Kingsport, TN 37660-4620

Phone

(423) 830-8110

NPI assigned

Sep 25, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Vanderbilt University School of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

SBH-KingsportGroup PAC ID 8325399256, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• SBH-Kingsport

  dba Creekside Behavioral Health

  • Psychiatric Hospital
  • Kingsport, TN
  • NPI 1174038749
  Medicare reassignment Care Compare group NPD
• Medpsych Inc. PC

  • Specialist
  • Kingsport, TN
  • NPI 1962828137
  Medicare reassignment NPD
• SBH-Kingsport

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Knoxville, TN
  • NPI 1801682299
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600992000000",
    "number": "1205443058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "458 HUNTERS CROSSING LN",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376645453",
            "telephone_number": "423-341-4475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 EXECUTIVE PARK BLVD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604620",
            "telephone_number": "423-830-8110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "CLINTON",
        "credential": "APRN, PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-25",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "28302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Charles Davidson
• Ashley Dawn Davis
• Ashley T Davis, FNP-C
• Clay Deneeen Davis, PA
• Clayton Edward Davis, D.D.S.
• Daniel Todd Davis, OTR/L
• Janna Evans Davis
• Joshua Blake Davis, PT, DPT, CSCS
• Kayla Annise Davis, LMSW
• Kristi Michelle Davis, BSW

• Psychiatric/Mental Health Nurse Practitioner in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.