Phyllis Davis Cosmetologist

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

BC107209275 Issued in IN

Legal business name

PHYLLIS DAVIS COSMETOLOGIST

Practice address

2336 E 53Rd St
Indianapolis, IN 46220-3430

Phone

(317) 259-2957

NPI assigned

Aug 7, 2014

Last updated

Aug 7, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Phyllis Terri Davis

Title

Cosmetologist

Phone

(317) 728-0045

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1407369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407369600000",
    "number": "1568871200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6057 TWYCKENHAM DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462367372",
            "telephone_number": "317-728-0045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2336 E 53RD ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462203430",
            "telephone_number": "317-259-2957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYLLIS DAVIS COSMETOLOGIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-07",
        "last_updated": "2014-08-07",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_middle_name": "TERRI",
        "authorized_official_title_or_position": "COSMETOLOGIST",
        "authorized_official_telephone_number": "317-728-0045"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "IN",
            "license": "BC107209275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.

Verify at the official NPI Registry.