Individual
TONYA DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGPCNP
Contact information
Practice address
3101 SE 14TH ST, BENTONVILLE, AR 72712-4900
(479) 986-6199
(479) 636-0371
Mailing address
PO BOX 507, LOWELL, AR 72745-0507
(913) 647-4100
(913) 647-4120
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
AP133496
TX
363LG0600X
Gerontology Nurse Practitioner
Primary
AP133496
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236258758
—
AR
05
—
420075835
—
MO
01
—
5E134
BCBS ARKANSAS
AR
01
—
P02334973
RAILROAD
AR
Enumeration date
03/05/2017
Last updated
06/18/2021
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