Healthcare Provider Details

I. General information

NPI: 1699683649
Provider Name (Legal Business Name): KISHANA DAVIS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 MURRAY PL
LYNCHBURG VA
24501-5004
US

IV. Provider business mailing address

4000 MURRAY PL
LYNCHBURG VA
24501-5004
US

V. Phone/Fax

Practice location:
  • Phone: 434-771-0172
  • Fax: 434-818-0943
Mailing address:
  • Phone: 434-771-0172
  • Fax: 434-818-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number0002108381
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: