Basic Information
| Provider Information | |||||||||
| NPI: | 1740296771 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DAVIS | ||||||||
| OtherFirstName: | LIZ | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | RNP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 25900 HUB RD | ||||||||
| Address2: | |||||||||
| City: | PARON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721229394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013511868 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5600 W 12TH ST | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722041717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017483333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | P01332 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | P01332 | 01 | AR | RNP LICENSE | OTHER |