Active NPI
Takeisha Charles Davis, MD, MPH
- Pediatrics Physician
- Thibodaux, LA
National Provider Identifier
1427048404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD200311
- Practice address
- 1434 Tiger Dr
Thibodaux, LA 70301-4337 - Phone
- (985) 447-0916
- Fax
- (985) 447-0920
- NPI assigned
- Oct 21, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD200311 | LA | Primary |
Addresses
Primary practice location
1434 Tiger Dr
Thibodaux, LA 70301-4337
Mailing address
1434 Tiger Dr
Thibodaux, LA 70301-4337
Phone (985) 447-0916
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64663 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD200311 | LA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407196800000",
"number": "1427048404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1434 TIGER DR",
"city": "THIBODAUX",
"state": "LA",
"postal_code": "703014337",
"telephone_number": "985-447-0916",
"fax_number": "985-447-0920"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1434 TIGER DR",
"city": "THIBODAUX",
"state": "LA",
"postal_code": "703014337",
"telephone_number": "985-447-0916",
"fax_number": "985-447-0920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "TAKEISHA",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "MD, MPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-10-21",
"last_updated": "2014-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "LA",
"license": "MD200311",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64663",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Thibodaux, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.