Individual
MARISSA K DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2204 PAVILION DR, SUITE 105, KINGSPORT, TN 37660-4657
(423) 392-6343
(423) 392-6159
Mailing address
2204 PAVILION DR, SUITE 105, KINGSPORT, TN 37660-4657
(423) 392-6343
(423) 392-6159
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN0000105257
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3635445
—
TN
Enumeration date
11/07/2005
Last updated
11/28/2011
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