Healthcare Provider Details

I. General information

NPI: 1013602622
Provider Name (Legal Business Name): HEATHER DAVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2400 MIAMI VALLEY DR
CENTERVILLE OH
45459-4774
US

IV. Provider business mailing address

1126 FAIRACRES RD
RICHMOND IN
47374-1146
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-2400
  • Fax:
Mailing address:
  • Phone: 703-200-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN.CNP.0033627
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0033627
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: