Healthcare Provider Details

I. General information

NPI: 1538223284
Provider Name (Legal Business Name): DAVID ASHLEY LIVESAY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 FULTON ST
DURHAM NC
27705-3875
US

IV. Provider business mailing address

508 FULTON ST
DURHAM NC
27705-3875
US

V. Phone/Fax

Practice location:
  • Phone: 919-212-0129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5009291
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: