Connie A Davis, APRN-BC

Individual provider Active NPI Family Nurse Practitioner · Stephens, AR

NPI 1366684193 · NPPES record last updated Mar 25, 2009

Key facts

NPI
1366684193
Entity type
Individual (NPI type 1)
Primary specialty
Family Nurse Practitioner 363LF0000X
License
ATP000195 (AR)
Practice address
113 W Ruby Street
Stephens, AR 71764
Phone
(870) 786-9114
Fax
(870) 786-5530
NPI assigned
Mar 25, 2009
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
ATP000195ARMDFamily Nurse Practitioner

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X ATP000195 AR Yes

Addresses

Primary practice location

113 W Ruby Street
Stephens, AR 71764

Mailing address

113 W Ruby Street
Stephens, AR 71764
Phone (870) 786-9114

Other providers in Stephens, AR

All providers in Stephens, AR · Family Nurse Practitioner in Arkansas

Sources for this page

Verify at the official NPI Registry.