Healthcare Provider Details

I. General information

NPI: 1164661468
Provider Name (Legal Business Name): STEPHEN JOHN DAVIS RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 WELLINGTON WAY STE 245
LEXINGTON KY
40513-1256
US

IV. Provider business mailing address

1031 WELLINGTON WAY STE 245
LEXINGTON KY
40513-1256
US

V. Phone/Fax

Practice location:
  • Phone: 859-368-0055
  • Fax:
Mailing address:
  • Phone: 859-368-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number642497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: