1164889952 NPI number — LACY DAVIDSON, MS, RDN, LD, RYT, LLC

Table of content: DR. GEORGE E. TRIPLETT PH.D. (NPI 1407831712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164889952 NPI number — LACY DAVIDSON, MS, RDN, LD, RYT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LACY DAVIDSON, MS, RDN, LD, RYT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164889952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
162 HONEYSUCKLE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25701-4726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-633-0675
Provider Business Mailing Address Fax Number:
304-405-2142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
162 HONEYSUCKLE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25701-4726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-633-0675
Provider Business Practice Location Address Fax Number:
304-405-2142
Provider Enumeration Date:
01/25/2016

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIDSON
Authorized Official First Name:
LACY
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-633-0675

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  934 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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