Healthcare Provider Details

I. General information

NPI: 1063028744
Provider Name (Legal Business Name): MAKAYLA DAVIDSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 CLEVELAND AVE
COLUMBUS OH
43231-2208
US

IV. Provider business mailing address

344 LAMBERT ST
GROVEPORT OH
43125-1365
US

V. Phone/Fax

Practice location:
  • Phone: 614-776-4646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0043565
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number463297
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: