Provider Demographics
NPI:1841014438
Name:DAVIS, ANNA CARLEEN (RD LD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:CARLEEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SAPPHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-4027
Mailing Address - Country:US
Mailing Address - Phone:304-216-2366
Mailing Address - Fax:
Practice Address - Street 1:300 SAPPHIRE CIR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-4027
Practice Address - Country:US
Practice Address - Phone:304-216-2366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV337133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered