Healthcare Provider Details

I. General information

NPI: 1962741199
Provider Name (Legal Business Name): SHERA DAVIS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 04/14/2024
Certification Date: 04/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELIZABETH PL
DAYTON OH
45417-3445
US

IV. Provider business mailing address

6258 HIGHWAY 235
NANCY KY
42544
US

V. Phone/Fax

Practice location:
  • Phone: 937-301-5897
  • Fax:
Mailing address:
  • Phone: 937-301-5897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4016530
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.145176-M-I V
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: