MEDICARE: MRS. COURTNEY LENORA DAVIS MSN, APRN,PMHNP-BC,

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	001267208	VA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024193930	VA

General Provider Information

NPI Number	:	1649994500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COURTNEY LENORA DAVIS MSN, APRN,PMHNP-BC,

Provider Business Mailing Address
First Line	:	1206 LASKIN RD STE 201G
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-5263
Country	:	US
Telephone Number	:	757-780-8153
Fax Number	:

Provider Business Practice Location Address
First Line	:	1206 LASKIN RD STE 201G
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-5263
Country	:	US
Telephone Number	:	757-780-8153
Fax Number	:

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

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	07/02/2025

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