Healthcare Provider Details

I. General information

NPI: 1902736655
Provider Name (Legal Business Name): HEATHER NICOLLE DAVIS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 CHAMBERS CIRCLE RD
WALKER WV
26180-3585
US

IV. Provider business mailing address

47 CHAMBERS CIRCLE RD
WALKER WV
26180-3585
US

V. Phone/Fax

Practice location:
  • Phone: 304-305-0257
  • Fax: 304-250-1739
Mailing address:
  • Phone: 304-305-0257
  • Fax: 304-250-1739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number35122
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: