Healthcare Provider Details

I. General information

NPI: 1851825491
Provider Name (Legal Business Name): CAITLIN DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13168 MEADOWVIEW SQUARE
MEADOWVIEW VA
24361
US

IV. Provider business mailing address

PO BOX 297
MEADOWVIEW VA
24361-0297
US

V. Phone/Fax

Practice location:
  • Phone: 276-944-3999
  • Fax: 276-944-3882
Mailing address:
  • Phone: 276-496-4492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2490
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: