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General NPI Number Information
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NPI Number | 1144651084
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Entity Type | Individual
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Provider Name | HEATHER A DAVIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 07/12/2019
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Provider Practice Location Address
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Address Line | 9471 MARKET ST STE A
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City | NORTH LIMA
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State | OH
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Zip | 44452-8702
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Country | US
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Telephone | 330-726-7100
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Fax | 330-758-0347
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Provider Business Mailing Address
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Address Line | 9471 MARKET ST STE A
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City | NORTH LIMA
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State | OH
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Zip | 44452-8702
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Country | US
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Telephone | 330-726-7100
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Fax | 330-758-0347
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 50003849
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.003849RX
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License Number State | OH
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