Provider Demographics
NPI:1841313632
Name:DAVIS, SHANN LYLE (PA-C)
Entity type:Individual
Prefix:MR
First Name:SHANN
Middle Name:LYLE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-5616
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:1881 PISGAH DR BLDG A
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3760
Practice Address - Country:US
Practice Address - Phone:828-697-4336
Practice Address - Fax:828-694-6757
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2022-01-17
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Provider Licenses
StateLicense IDTaxonomies
NC103610363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant