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General NPI Number Information
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NPI Number | 1639785074
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Entity Type | Individual
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Provider Name | SAMANTHA NICOLE CHESSON DAVIS FNP
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Gender | Female
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Dates
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Enumeration Date | 09/21/2020
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 853 WASHINGTON SQUARE MALL
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City | WASHINGTON
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State | NC
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Zip | 27889-3530
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Country | US
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Telephone | 252-623-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 1280 TALL TIMBERS E
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City | WILLIAMSTON
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State | NC
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Zip | 27892-7202
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Country | US
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Telephone | 252-799-9128
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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 | 5013588
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License Number State | NC
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