Individual
PETISHA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1700 RAINBOW BLVD, EXCELSIOR SPRINGS, MO 64024-1182
(816) 630-6081
(816) 629-3661
Mailing address
14951 M HIGHWAY, RAYVILLE, MO 64084-9074
(816) 807-6228
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
14106475111
KS
363LF0000X
Family Nurse Practitioner
Primary
2008007305
MO
Other
Enumeration date
02/26/2016
Last updated
04/12/2016
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