Laurie Deanne Davis, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · East Ridge, TN
NPI 1659332385 · NPPES record last updated Sep 12, 2014
Key facts
- NPI
- 1659332385
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 07173 (TN)
- Practice address
- 1508 Tombras Ave
East Ridge, TN 37412-2720 - Phone
- (423) 867-4969
- Fax
- (423) 867-4971
- NPI assigned
- Mar 31, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Your Good Health, LLC
Practice addresses (Care Compare)
14 Fort Town Dr
Ft Oglethorpe, GA 30742-4051
Phone (706) 866-4443
1508 Tombras Ave
East Ridge, TN 37412-2720
Phone (423) 867-4969
Hospital & facility affiliations
- Memorial Healthcare System, Inc
- Erlanger Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN, GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050413000246 | TN | Practitioner - Nurse Practitioner | 1951348705 | Reassigns benefits to 1 organization |
| I20140625002121 | GA | Practitioner - Nurse Practitioner | 1951348705 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07173 | TN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centennial Housing & Community Services Corporation | Past | Accepting new patients |
Interoperability endpoints
- laurie.davis@ingoodhealth.directbygreenway.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 07173 | TN | Yes |
| Family Nurse Practitioner | 363LF0000X | 218675 | GA |
Addresses
Primary practice location
1508 Tombras Ave
East Ridge, TN 37412-2720
Mailing address
1508 Tombras Ave
East Ridge, TN 37412-2720
Phone (423) 867-4969
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 510329585A | Medicaid | GA | |
| 1507242 | Medicaid | TN | |
| 4155074 | Other | TN | BCBS - TENNESSEE |
Other providers in East Ridge, TN
- Cole Vision Corporation
- Comprehensive Medical Supply
- Annunciata Marie-Victoria Corey
- Crossroads Urgent Care, PLLC
- Karon Annette Culp
- Tamara Karaba Davis
- Kara Debord
- Dialysis Clinic Inc.
- Wendy Kay Dodd
- DT Transportation
All providers in East Ridge, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.