Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 582080 | TX |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 582080 | TX |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 582080 | TX |
N | 363LP0222X | Nurse Practitioner Pediatrics (Critical Care) | 582080 | TX |
NPI | 1326153198 |
---|---|
Provider Name | Timothy C Davis |
First Address | Dallas, TX 75211-1805 |
Second Address | Brownwood, TX 76801-5918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 28/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1742694 | (05) | TX |