NPIMap

Individual provider Active NPI

Nora Cecelia Gough-Davis, FNP

  • Family Nurse Practitioner
  • Shaw, MS
National Provider Identifier
1740410661
Registry record updated Apr 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R872155 Issued in MS
Practice address
112 W Peeler Ave
Shaw, MS 38773-8710
Phone
(662) 754-3301
Fax
(662) 754-3304
NPI assigned
Jul 27, 2009
Last updated
Apr 14, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R872155 MS Primary

Addresses

Primary practice location

112 W Peeler Ave
Shaw, MS 38773-8710

Mailing address

112 W Peeler Ave
P.O. Box 299
Shaw, MS 38773-8710
Phone (662) 754-3301

Other identifiers 1

IdentifierTypeStateIssuer
09801514MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100120000411 MS Practitioner - Nurse Practitioner 0749322345 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Making Moves in the Community IncorporatedGroup PAC ID 4284038738, 2 clinicians

Practice addresses (Care Compare)

112 W Peeler Ave
Shaw, MS 38773-8710
Phone (662) 754-3301

715 S Martin Luther King Dr
Cleveland, MS 38732-3526
Phone (662) 402-1138

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R872155MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Shaw Family Medical, LLC Family CurrentSince Jun 16, 2012 Accepting new patients
Boa Vida Hospital of Aberdeen, Ms LLC CurrentSince May 15, 2025 Accepting new patients
Davis Unlimited Healthcare Services, PLLC Family Current Accepting new patients
Boa Vida Hospital of Aberdeen, Ms, LLC CurrentSince Dec 20, 2025 Accepting new patients
Boa Vida Hospital of Aberdeen, Ms, LLC Current Accepting new patients
Shaw Family Medical, LLC CurrentSince Jun 16, 2012 Accepting new patients
Making Moves in the Community, Incorporated CurrentSince Oct 1, 2022 Accepting new patients
Boa Vida Hospital of Aberdeen, Ms, LLC Past Accepting new patients
Boa Vida Hospital of Aberdeen, Ms LLC Past Accepting new patients
Boa Vida Hospital of Aberdeen, Ms LLC Past Accepting new patients

Locations

400 S Chestnut St
Aberdeen, MS 39730
Phone (662) 369-2455

715 S Martin Luther King Dr
Cleveland, MS 38732

189 N Main St
Drew, MS 38737
Phone (662) 745-6638

601 Highway 61
Shaw, MS 38773
Phone (662) 545-7014

Organizations & group practices 15

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

View all 15

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1248652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1740410661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 W PEELER AVE",
            "address_2": "P.O. BOX 299",
            "city": "SHAW",
            "state": "MS",
            "postal_code": "387738710",
            "telephone_number": "662-754-3301",
            "fax_number": "662-754-3304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 W PEELER AVE",
            "city": "SHAW",
            "state": "MS",
            "postal_code": "387738710",
            "telephone_number": "662-754-3301",
            "fax_number": "662-754-3304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOUGH-DAVIS",
        "first_name": "NORA",
        "middle_name": "CECELIA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-27",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R872155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09801514",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shaw, MS

Sources for this page

Verify at the official NPI Registry.