Provider Demographics
NPI:1679932321
Name:DAVIS, NICOLE (APRN, FNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 W VILLAGE PKWY STE 10
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8137
Mailing Address - Country:US
Mailing Address - Phone:479-657-6600
Mailing Address - Fax:479-657-6632
Practice Address - Street 1:5206 W VILLAGE PKWY STE 10
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8137
Practice Address - Country:US
Practice Address - Phone:479-657-6600
Practice Address - Fax:479-657-6632
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily