Joanna Brooke Davis

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA15824 Issued in FL

Practice address

930 N Ferdon Blvd
Crestview, FL 32536-1706

Phone

(850) 331-2987

NPI assigned

Dec 19, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Brooke Davis Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1513641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594771200000",
    "number": "1376059907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2411 HALFMOON LN",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325364374",
            "telephone_number": "850-257-4766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 N FERDON BLVD",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325361706",
            "telephone_number": "850-331-2987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JOANNA",
        "middle_name": "BROOKE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-19",
        "last_updated": "2020-07-15",
        "certification_date": "2020-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA15824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "1497122725",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BROOKE",
            "last_name": "DAVIS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Brooke Kitty Dale, BCBA
• Lita Marie Danlag, FNP-C
• David a Herf, MD
• Aubree A Davis
• Barabra Davis, RN
• Marsha Davis
• Melissa Davis, CCC/SLP
• Shelby Davis
• Alyssa Dawson
• Cassandra Dayton

• Speech-Language Pathologist in Crestview, FL
• Providers in Crestview, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.