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General NPI Number Information
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NPI Number | 1548082399
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Entity Type | Individual
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Provider Name | LESLIE L. DAVIS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 1013 GARFIELD AVE
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City | PARKERSBURG
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State | WV
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Zip | 26101-3290
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Country | US
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Telephone | 304-424-4574
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Fax | 304-424-4429
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Provider Business Mailing Address
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Address Line | 920 MYERS FORK RD
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City | PETROLEUM
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State | WV
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Zip | 26161-6416
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Country | US
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Telephone | 304-834-0484
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 120967
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License Number State | WV
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