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NPI Code Detail

MEDICARE: RICHARD DAVIS

MEDICARE: RICHARD DAVIS
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
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1174193700
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD DAVIS
Provider Business Mailing Address
First Line : 72 BLACKBERRY LN
Second Line :
City : WINFIELD
State : WV
Zip : 25213-9364
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5512 BIG TYLER RD
Second Line :
City : CROSS LANES
State : WV
Zip : 25313-1304
Country : US
Telephone Number : 304-766-9830
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2021
Last Update Date : 06/27/2021

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Directions to “ RICHARD DAVIS ” Practice Location

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