Provider Demographics
NPI:1447837638
Name:DAVIS, SARAH ASHLEY TUCKER (DO)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ASHLEY TUCKER
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1035 1ST AVE W
Mailing Address - Street 2:#220
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-258-4789
Mailing Address - Fax:406-258-4732
Practice Address - Street 1:1280 BURNS WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3110
Practice Address - Country:US
Practice Address - Phone:406-755-5266
Practice Address - Fax:406-755-0228
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT144826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine