Basic Information
| Provider Information | |||||||||
| NPI: | 1578902581 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | MICHELLE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4046 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658084046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172697241 | ||||||||
| FaxNumber: | 4172697567 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 BRANSON LANDING | ||||||||
| Address2: | STE 508 | ||||||||
| City: | BRANSON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656162131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173357540 | ||||||||
| FaxNumber: | 4173357544 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 208000000X | 94-08241 | KS | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 2016021059 | MO | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.