Provider Demographics
NPI:1053703132
Name:DAVIS, AMMY HUTTON (CPNP)
Entity type:Individual
Prefix:MRS
First Name:AMMY
Middle Name:HUTTON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 BARNETT BEND DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7600
Mailing Address - Country:US
Mailing Address - Phone:601-259-2033
Mailing Address - Fax:
Practice Address - Street 1:514H E WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4538
Practice Address - Country:US
Practice Address - Phone:601-713-3900
Practice Address - Fax:601-713-3970
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09490363LP0200X
MSR878833363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics