=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720875552
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANESSA ALEXANDRA DENISE DAVIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2025
-----------------------------------------------------
Last Update Date | 09/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 781 CHESTERFIELD HWY
-----------------------------------------------------
City | CHERAW
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29520-7002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-307-7456
-----------------------------------------------------
Fax | 843-690-2602
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 781 CHESTERFIELD HWY
-----------------------------------------------------
City | CHERAW
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29520-7002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-690-2600
-----------------------------------------------------
Fax | 843-690-2602
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F04250187
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------