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General NPI Number Information
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NPI Number | 1538715974
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Entity Type | Individual
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Provider Name | BRANDON HEATH DAVIS LPN
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Gender | Male
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Dates
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Enumeration Date | 08/12/2019
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Last Update Date | 08/12/2019
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Provider Practice Location Address
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Address Line | 602 DAVID ST
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City | CORNING
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State | AR
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Zip | 72422-7268
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Country | US
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Telephone | 870-857-3655
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Fax | 870-357-3667
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Provider Business Mailing Address
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Address Line | 602 DAVID ST
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City | CORNING
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State | AR
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Zip | 72422-7268
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Country | US
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Telephone | 870-857-3655
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Fax | 870-857-3667
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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 | L50333
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License Number State | AR
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