Provider Demographics
NPI:1366693905
Name:DAVIS, LAURA ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ELIZABETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-633-3525
Mailing Address - Fax:502-633-3825
Practice Address - Street 1:515 HOSPITAL DR
Practice Address - Street 2:SUITE # 1
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1619
Practice Address - Country:US
Practice Address - Phone:502-633-3525
Practice Address - Fax:502-633-3825
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2010-11-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-00796363A00000X
KYPA1183363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100129070Medicaid
KY7100129070Medicaid