Debra Mollie Davis, RN BSN

Primary specialty

Case Management Registered NurseTaxonomy code 163WC0400X

Practice address

2079 Edgewater Dr
Pekin, IL 61554

Phone

(309) 382-2006

Fax

(309) 382-2007

NPI assigned

Apr 17, 2007

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 names 1

• Debra Mollie Walters Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bridgeway Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pekin, IL
  • NPI 1346524899
  NPD (past)
• Bridgeway Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Normal, IL
  • NPI 1588948046
  NPD (past)
• Bridgeway, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Galesburg, IL
  • NPI 1154545879
  NPD (past)
• Bridgeway, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kewanee, IL
  • NPI 1578788188
  NPD (past)
• Bridgeway, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Macomb, IL
  • NPI 1760505044
  NPD (past)

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376769638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "587 E COURT ST",
            "city": "FARMINGTON",
            "state": "IL",
            "postal_code": "615311303",
            "telephone_number": "309-245-2862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2079 EDGEWATER DR",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "61554",
            "telephone_number": "309-382-2006",
            "fax_number": "309-382-2007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "DEBRA",
        "middle_name": "MOLLIE",
        "credential": "RN BSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBRA",
            "last_name": "WALTERS",
            "middle_name": "MOLLIE",
            "credential": "RN BSN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mari Teresa Cullen, BA, CADC
• Ivetta S Daccache, O.D.
• Rebekah A Dagraedt
• Michael David Danner, D.D.S.
• Char Davis, PHDH
• Stacey Day
• Scarlet Deluhery, LPN
• Anthony John Demonte, DSS
• Dennis K Stoller DDS LTD
• Tonya Lynn Dennison, FNP

• Case Management Registered Nurse in Pekin, IL
• Providers in Pekin, IL by specialty
• Case Management Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.