Basic Information
| Provider Information | |||||||||
| NPI: | 1508845538 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | CARTER | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1005 DR. D. B. TODD BLVD | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153275524 | ||||||||
| FaxNumber: | 6153275541 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 DR. D. B. TODD BLVD | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153275524 | ||||||||
| FaxNumber: | 6153275541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 10/13/2016 | ||||||||
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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 | 163WR1000X | RN135639 | TN | N | Nursing Service Providers | Registered Nurse | Reproductive Endocrinology/Infertility | 363LX0001X | 8290 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 3929805 | 05 | TN | MEDICAID |