Provider Demographics
NPI:1942474770
Name:DAVIS, MICHELLE LOUISE (FNP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LOUISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP
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 60126
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29419-0126
Mailing Address - Country:US
Mailing Address - Phone:843-412-4899
Mailing Address - Fax:
Practice Address - Street 1:106 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-2601
Practice Address - Country:US
Practice Address - Phone:843-761-1995
Practice Address - Fax:843-761-3257
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP49447Medicare UPIN