Provider Demographics
NPI:1720875552
Name:DAVIS, VANESSA ALEXANDRA DENISE
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ALEXANDRA DENISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 CHESTERFIELD HWY
Mailing Address - Street 2:
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-7002
Mailing Address - Country:US
Mailing Address - Phone:843-690-2600
Mailing Address - Fax:843-690-2602
Practice Address - Street 1:781 CHESTERFIELD HWY
Practice Address - Street 2:
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-7002
Practice Address - Country:US
Practice Address - Phone:843-307-7456
Practice Address - Fax:843-690-2602
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF04250187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily