Provider Demographics
NPI:1912931882
Name:DAVIS, LYNN VALERIE (CFNP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:VALERIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12901 BRIGGS ROAD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831
Mailing Address - Country:US
Mailing Address - Phone:804-796-2373
Mailing Address - Fax:804-748-9160
Practice Address - Street 1:12901 BRIGGS RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831
Practice Address - Country:US
Practice Address - Phone:765-494-6341
Practice Address - Fax:765-496-1022
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002141A207Q00000X
VA0024123859207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200852830Medicaid
VA200852830Medicaid
IN200852830Medicaid
VA200852830Medicaid