MEDICARE: HEATHER T. DAVIS APRN

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
1	363L00000X	Nurse Practitioner	3005719	KY
2	363LF0000X	Family Nurse Practitioner	3005719	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851549711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER T. DAVIS APRN

Provider Business Mailing Address
First Line	:	121 E MAIN ST
Second Line	:	P.O. BOX 310
City	:	PROVIDENCE
State	:	KY
Zip	:	42450-1268
Country	:	US
Telephone Number	:	270-667-2023
Fax Number	:	270-667-7518

Provider Business Practice Location Address
First Line	:	121 E MAIN ST
Second Line	:
City	:	PROVIDENCE
State	:	KY
Zip	:	42450-1268
Country	:	US
Telephone Number	:	270-667-2023
Fax Number	:	270-667-7518

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	03/07/2023

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