Henry Edward Davis Jr., APRN CNP
Individual provider Active NPI Nurse Practitioner · Minco, OK
NPI 1982194320 · NPPES record last updated Mar 10, 2025
Key facts
- NPI
- 1982194320
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 57710 (OK)
- Practice address
- 1100 SW 3Rd St
Minco, OK 73059-3044 - Phone
- (405) 320-9431
- Fax
- (405) 689-3008
- NPI assigned
- May 11, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
1100 SW 3Rd St
Minco, OK 73059-3044
Phone (405) 381-8380
Hospital & facility affiliations
- Integris Canadian Valley Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- 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 |
|---|---|---|---|---|
| I20181112000068 | OK | Practitioner - Nurse Practitioner | 5698029635 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57710 | OK | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Compassionate Family Urgent Care LLC | Current |
Accepting new patients | |
| Summit Medical Center | Past | Accepting new patients |
Locations
1100 SW 3rd St
Minco, OK 73059
Phone (405) 206-8192
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 57710 | OK | Yes |
Addresses
Primary practice location
1100 SW 3Rd St
Minco, OK 73059-3044
Mailing address
1100 SW 3Rd St
Minco, OK 73059-3044
Phone (405) 381-8380
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200811100A | Medicaid | OK |
Other providers in Minco, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2025. 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.