Provider Demographics
NPI:1881951994
Name:DAVIS, MICHELLE L (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-0808
Mailing Address - Country:US
Mailing Address - Phone:423-442-2121
Mailing Address - Fax:423-545-9556
Practice Address - Street 1:401 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3468
Practice Address - Country:US
Practice Address - Phone:423-745-6610
Practice Address - Fax:423-745-6360
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN16622363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ000332Medicaid
TNQ000332Medicaid
TNQ000332Medicaid