Basic Information
| Provider Information | |||||||||
| NPI: | 1053313536 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 425 | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | WHITEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284720425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239155233 | ||||||||
| FaxNumber: | 4239523109 | ||||||||
| Practice Location | |||||||||
| Address1: | 4276 LEGEND AVENUE | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283033497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108670035 | ||||||||
| FaxNumber: | 9108670545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 07/27/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 110512 | NE | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | 2006023930 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | 200842 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 6113058 | 05 | NC | MEDICAID | 31594 | 01 | NE | BLUE CROSS BLUE SHIELD NE | OTHER |