Healthcare Provider Details

I. General information

NPI: 1063175594
Provider Name (Legal Business Name): REBEKAH CHRISTINE DAVIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 CAMPUS DR
ABINGDON VA
24210-9700
US

IV. Provider business mailing address

PO BOX 9
KINGSPORT TN
37662-0009
US

V. Phone/Fax

Practice location:
  • Phone: 276-676-3870
  • Fax: 276-628-8927
Mailing address:
  • Phone: 423-857-2093
  • Fax: 423-390-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024182721
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: