Provider Demographics
NPI:1023324167
Name:DAVIS, BILLY WAYNE (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:BILLY
Middle Name:WAYNE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 73 BOX 6
Mailing Address - Street 2:
Mailing Address - City:GLEN FORK
Mailing Address - State:WV
Mailing Address - Zip Code:25845-8824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HC 73 BOX 6
Practice Address - Street 2:
Practice Address - City:GLEN FORK
Practice Address - State:WV
Practice Address - Zip Code:25845-8824
Practice Address - Country:US
Practice Address - Phone:304-682-4425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV60155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily