Individual
TIMOTHY C DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN,PNP
Contact information
Practice address
104 S PARK DR, BROWNWOOD, TX 76801-5918
(325) 646-0704
(325) 646-1513
Mailing address
2330 BARBERRY DR, DALLAS, TX 75211-1805
(214) 529-1859
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
582080
TX
363LN0005X
Critical Care Neonatal Nurse Practitioner
582080
TX
363LP0200X
Pediatric Nurse Practitioner
Primary
582080
TX
363LP0222X
Critical Care Pediatric Nurse Practitioner
582080
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1742694
—
TX
Enumeration date
08/20/2006
Last updated
11/28/2012
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