=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912519091
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LATRESA CHAVAL DAVIS CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2020
-----------------------------------------------------
Last Update Date | 01/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3737 GOVERNMENT BLVD STE 408
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36693-4362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-602-1911
-----------------------------------------------------
Fax | 251-602-1850
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3737 GOVERNMENT BLVD STE 408
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36693-4362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-602-1911
-----------------------------------------------------
Fax | 251-602-1850
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 1-137115
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | RN243422
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------