Nicolette Threatt Davis, PA
Physician Assistant in Charlotte, NC. Individual provider (NPI-1).
NPI number1861677445
StatusActive
Last updated in NPPESJul 15, 2024
Details
- NPI
- 1861677445
- Entity type
- Individual (NPI-1)
- Name
- Nicolette Threatt Davis
- Credential
- PA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 2, 2008
- Last updated
- Jul 15, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 0010-06734 | NC | Yes |
Practice location
5727 Prosperity Crossing DrSte 1100
Charlotte, NC 28269-2206
Phone 704-863-9930
Mailing address
Po Box 19305Charlotte, NC 28219-9305
Other practice locations
5717 Albemarle Rd
Charlotte, NC 28212-1634
Charlotte, NC 28212-1634
Phone 704-563-2150
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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