Provider Demographics
NPI:1972922995
Name:DAVIS, WESLEY DANIEL (DNP, APRN)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:DANIEL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 CANE MILL CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:PATRICK
Mailing Address - State:SC
Mailing Address - Zip Code:29584-4537
Mailing Address - Country:US
Mailing Address - Phone:843-623-4463
Mailing Address - Fax:
Practice Address - Street 1:467 CANE MILL CROSSING RD
Practice Address - Street 2:
Practice Address - City:PATRICK
Practice Address - State:SC
Practice Address - Zip Code:29584-4537
Practice Address - Country:US
Practice Address - Phone:843-623-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY28492.1332363LA2100X, 363L00000X
SC90569163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner