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General NPI Number Information
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NPI Number | 1710245444
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Entity Type | Individual
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Provider Name | STACY LYNN DAVIDSON CRNP
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Gender | Female
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 02/25/2018
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Provider Practice Location Address
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Address Line | 7300 HALCYON SUMMIT DR
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City | MONTGOMERY
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State | AL
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Zip | 36117-3699
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Country | US
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Telephone | 205-977-9876
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Fax | 205-977-9976
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Provider Business Mailing Address
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Address Line | 1940 STONEGATE DR STE 130
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City | VESTAVIA HLS
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State | AL
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Zip | 35242-2541
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Country | US
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Telephone | 205-977-9876
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Fax | 205-977-9976
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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 | 1-085135
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License Number State | AL
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