Active NPI
Linda Davis, PA
- Physician Assistant
- Fort Worth, TX
National Provider Identifier
1497719371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA02755
- Practice address
- 903 Summit Ave
Fort Worth, TX 76102-3421 - Phone
- (817) 877-5353
- Fax
- (817) 877-5357
- NPI assigned
- Apr 17, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA02755 | TX | |
| Physician Assistant | 363A00000X | PA02755 | TX | Primary |
Addresses
Primary practice location
903 Summit Ave
Fort Worth, TX 76102-3421
Mailing address
903 Summit Ave
Fort Worth, TX 76102-3421
Phone (817) 877-5353
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8N2936 | Other | TX | BCBS |
| 196496702 | Medicaid | TX | |
| 196496703 | Medicaid | TX | |
| 196496701 | Medicaid | TX | |
| 196496704 | Medicaid | TX | |
| P00137420 | Other | TX | RAILROAD MEDICARE |
| 196496705 | Medicaid | TX |
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)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340841600000",
"number": "1497719371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "903 SUMMIT AVE",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761023421",
"telephone_number": "817-877-5353",
"fax_number": "817-877-5357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "903 SUMMIT AVE",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761023421",
"telephone_number": "817-877-5353",
"fax_number": "817-877-5357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "LINDA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-17",
"last_updated": "2012-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA02755",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA02755",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8N2936",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "196496702",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "196496703",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "196496701",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "196496704",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00137420",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "196496705",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.