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NPI Code Detail

MEDICARE: ANTHONY DAVIS LPN

MEDICARE: ANTHONY DAVIS LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse2052291KY

General Provider Information

NPI Number : 1063342392
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHONY DAVIS LPN
Provider Business Mailing Address
First Line : 1073 ARBUCKLE RD
Second Line :
City : SUMMERSVILLE
State : WV
Zip : 26651-1745
Country : US
Telephone Number : 304-244-1453
Fax Number :
Provider Business Practice Location Address
First Line : 1073 ARBUCKLE RD
Second Line :
City : SUMMERSVILLE
State : WV
Zip : 26651-1745
Country : US
Telephone Number : 304-244-1453
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2026
Last Update Date : 05/20/2026

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Directions to “ ANTHONY DAVIS LPN” Practice Location

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