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General NPI Number Information
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NPI Number | 1558132969
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Entity Type | Individual
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Provider Name | MYKAELA DAVIS PA
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Gender | Female
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 100 FAIR ST
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City | MIDDLEBOURNE
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State | WV
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Zip | 26149-9525
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Country | US
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Telephone | 304-758-5000
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Fax | 304-758-5022
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Provider Business Mailing Address
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Address Line | 416 COLEGATE DR BLDG 3
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City | MARIETTA
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State | OH
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Zip | 45750-9549
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Country | US
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Telephone | 740-374-3526
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Fax | 740-374-3165
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2925
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License Number State | WV
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