Provider Demographics
NPI:1548147200
Name:DAVIS, WALTER ANTHONY III (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:ANTHONY
Last Name:DAVIS
Suffix:III
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21954 PALOMINO WAY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19933-4578
Mailing Address - Country:US
Mailing Address - Phone:302-519-7041
Mailing Address - Fax:
Practice Address - Street 1:18335 COASTAL HWY STE 102
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-2738
Practice Address - Country:US
Practice Address - Phone:302-519-7041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0013302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily