Mariah Patrice Davis
Individual provider Active NPI Registered Nurse · Scurry, TX
NPI 1366016396 · NPPES record last updated May 14, 2021
Key facts
- NPI
- 1366016396
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 210583 (LA)
- Practice address
- 6590 Shady Lane
Scurry, TX 75158 - Phone
- (469) 721-6621
- NPI assigned
- May 14, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 210583 | LA | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 210583 | LA | Yes |
Addresses
Primary practice location
6590 Shady Lane
Scurry, TX 75158
Mailing address
813 Cherokee St
New Iberia, LA 70560-5681
Phone (337) 577-7266
Other providers in Scurry, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 14, 2021. 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.