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General NPI Number Information
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NPI Number | 1124842216
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Entity Type | Individual
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Provider Name | MICHAEL ALEX DAVIDSON LICENSED PRACTICAL N
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Gender | Male
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 3615 WEST 25TH STREET
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City | LITTLE ROCK
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State | AR
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Zip | 72204
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Country | US
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Telephone | 501-500-0558
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Fax |
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Provider Business Mailing Address
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Address Line | 3 WOODBERRY ROAD
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City | LITTLE ROCK
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State | AR
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Zip | 72212-2741
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Country | US
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Telephone | 501-366-8683
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | L057160
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License Number State | AR
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