Provider Demographics
NPI:1821863697
Name:DAVIS, PATRICIA TAYLOR
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:TAYLOR
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45135-9661
Mailing Address - Country:US
Mailing Address - Phone:937-218-9929
Mailing Address - Fax:
Practice Address - Street 1:309 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:OH
Practice Address - Zip Code:45135-9661
Practice Address - Country:US
Practice Address - Phone:937-218-9929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker