Charles Robert Davis, FNP
Individual provider Active NPI Family Nurse Practitioner · Amenia, NY
NPI 1235871971 · NPPES record last updated Apr 12, 2022
Key facts
- NPI
- 1235871971
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- F345256-01 (NY)
- Practice address
- 194 Haight Rd
Amenia, NY 12501-5234 - Phone
- (845) 373-4100
- NPI assigned
- Apr 12, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F345256-01 | NY | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Open Door Family Medical Center, Inc. | Past |
Accepting new patients | |
| Northeast CSD | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | F345256-01 | NY | Yes |
Addresses
Primary practice location
194 Haight Rd
Amenia, NY 12501-5234
Mailing address
Webutuck School Based Health Center
194 Haight Road
Amenia, NY 12524
Other providers in Amenia, NY
- Tara Camo
- Alexandra Cernasov
- Zhi Wei Cheung
- Michele Leigh Craven
- Creating Connections SLP & OT, PLLC
- Margaret Mary Day
- Robert Dweck
- Lorraine Gallo
- Michelle Gomez
- Sarah K Gray
All providers in Amenia, NY · Family Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.