Individual
LACY MICHELLE DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
5170 US RT 60 EAST, HUNTINGTON, WV 25705
(304) 528-4600
Mailing address
5170 US RT 60 EAST, HUNTINGTON, WV 25705
(304) 528-4600
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
934
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01249406
RAILROAD MEDICARE
—
Enumeration date
09/05/2013
Last updated
03/21/2014
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