Healthcare Provider Details

I. General information

NPI: 1235016072
Provider Name (Legal Business Name): ALLISON MCKENDREE DAVIS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 MACCORKLE AVE SW
SOUTH CHARLESTON WV
25309-1311
US

IV. Provider business mailing address

134 RANGER LN
SOUTH CHARLESTON WV
25309-6092
US

V. Phone/Fax

Practice location:
  • Phone: 304-766-3601
  • Fax:
Mailing address:
  • Phone: 304-444-2613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number15932
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: