Healthcare Provider Details

I. General information

NPI: 1396649596
Provider Name (Legal Business Name): MELISSA SUE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 COSHOCTON AVE
MOUNT VERNON OH
43050-1495
US

IV. Provider business mailing address

907 W MARTINDALE RD
UNION OH
45322-2929
US

V. Phone/Fax

Practice location:
  • Phone: 740-393-9000
  • Fax:
Mailing address:
  • Phone: 740-221-8604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN.CNP.0043516
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: