Healthcare Provider Details

I. General information

NPI: 1780759605
Provider Name (Legal Business Name): NATALIE A. DAVIS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATALIE A. BLACK M.D

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S 12TH ST
MURRAY KY
42071-9303
US

IV. Provider business mailing address

240 GRACE NELL DR
PADUCAH KY
42003-5797
US

V. Phone/Fax

Practice location:
  • Phone: 270-759-9200
  • Fax: 270-759-9966
Mailing address:
  • Phone: 270-331-0218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number109023
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43241
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: