Mark Anthony Davis, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP61526319 Issued in WA

Practice address

1520 Kelly PL
Walla Walla, WA 99362-8607

Phone

(509) 575-4084

NPI assigned

Feb 8, 2024

Last updated

Feb 8, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 WA

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

Other, 2023

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Comprehensive HealthcareGroup PAC ID 7618875022, 32 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Comprehensive Healthcare

  • Community/Behavioral Health Agency
  • Yakima, WA
  • NPI 1073527453
  Medicare reassignment Care Compare group NPD
• Comprehensive Healthcare

  • Methadone Clinic
  • Yakima, WA
  • NPI 1588871693
  NPD
• Comprehensive Healthcare

  • Community/Behavioral Health Agency
  • Walla Walla, WA
  • NPI 1902236144
  NPD (past)

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

{
    "created_epoch": "1707350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707350400000",
    "number": "1265296412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 KELLY PL",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993628607",
            "telephone_number": "509-575-4084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 KELLY PL",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993628607",
            "telephone_number": "509-575-4084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MARK",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-02-08",
        "last_updated": "2024-02-08",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61526319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Davis Sameh Meeker Laboratories PS
• Davis Sameh Meeker Laboratories PS
• Elizabeth Boatright Davis, LMFTA
• Helen Davis, M.A., L.M.T.
• Madison Mackenzie Davis, LSWAIC
• Patrick Edward Davis, MD
• Steven J. Davis, O.D.
• Timothy J Davis, AU.D.
• Pamela J Daws, R.D.
• Jennifer Dawson, LCSW

• Psychiatric/Mental Health Nurse Practitioner in Walla Walla, WA
• Providers in Walla Walla, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; 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.