Healthcare Provider Details

I. General information

NPI: 1083442040
Provider Name (Legal Business Name): COURTNEY LEIGH DAVIES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 ASH ST STE 1
DUNMORE PA
18509-2909
US

IV. Provider business mailing address

1101 S VALLEY AVE
OLYPHANT PA
18447-2217
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-2244
  • Fax:
Mailing address:
  • Phone: 570-468-0066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA065697
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: