Provider Demographics
NPI:1407016983
Name:DAVIS, BETH ANN (MPA, RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MPA, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 WESTERN BOULEVARD
Mailing Address - Street 2:ONSLOW MEMORIAL HOSPITAL
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546
Mailing Address - Country:US
Mailing Address - Phone:910-577-4820
Mailing Address - Fax:910-577-2322
Practice Address - Street 1:317 WESTERN BLVD
Practice Address - Street 2:ONSLOW MEMORIAL HOSPITAL
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6338
Practice Address - Country:US
Practice Address - Phone:910-577-4820
Practice Address - Fax:910-577-2322
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003075133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered