Provider Demographics
NPI:1255084489
Name:DAVIS, PATRICIA ANN
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
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 1:539 CONWAY RD APT 202
Mailing Address - Street 2:
Mailing Address - City:FAIR BLUFF
Mailing Address - State:NC
Mailing Address - Zip Code:28439-9546
Mailing Address - Country:US
Mailing Address - Phone:843-877-6591
Mailing Address - Fax:
Practice Address - Street 1:539 CONWAY RD APT 202
Practice Address - Street 2:
Practice Address - City:FAIR BLUFF
Practice Address - State:NC
Practice Address - Zip Code:28439-9546
Practice Address - Country:US
Practice Address - Phone:843-877-6591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
3747A0650XOtherCAREGIVER