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General NPI Number Information
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NPI Number | 1720355977
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Entity Type | Individual
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Provider Name | LESLIE A DAVIS APRN
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Gender | Female
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 05/15/2018
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Provider Practice Location Address
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Address Line | 5607 DICKENSON HWY
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City | CLINTWOOD
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State | VA
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Zip | 24228
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Country | US
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Telephone | 276-926-4601
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Fax | 276-926-4602
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Provider Business Mailing Address
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Address Line | 5607 DICKENSON HWY
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City | CLINTWOOD
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State | VA
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Zip | 24228-7099
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Country | US
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Telephone | 276-926-4601
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Fax | 276-926-4602
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3007214
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024169761
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License Number State | VA
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