Individual
MRS. TEARSANEE CARLISLE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, FNP-BC
Contact information
Practice address
2500 N STATE ST, DEPT OF FAMILY MEDICINE, JACKSON, MS 39216-4500
(601) 815-2022
(601) 815-2036
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-3992
(601) 984-5583
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R857403
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01888853
—
MS
01
—
512I500604
MEDICARE PTAN#
MS
Enumeration date
10/27/2006
Last updated
05/05/2015
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