MEDICARE: MS. LESLIE PETTWAY DAVIS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	1-171067	AL

General Provider Information

NPI Number	:	1235001678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LESLIE PETTWAY DAVIS RN

Provider Business Mailing Address
First Line	:	100 QUAIL RIDGE DR
Second Line	:
City	:	VALLEY GRANDE
State	:	AL
Zip	:	36703-1532
Country	:	US
Telephone Number	:	334-413-1039
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 QUAIL RIDGE DR
Second Line	:
City	:	VALLEY GRANDE
State	:	AL
Zip	:	36703-1532
Country	:	US
Telephone Number	:	334-413-1039
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2025
Last Update Date	:	10/24/2025

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