Provider Demographics
NPI:1235001678
Name:DAVIS, LESLIE PETTWAY (RN)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:PETTWAY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:PETTWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:100 QUAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY GRANDE
Mailing Address - State:AL
Mailing Address - Zip Code:36703-1532
Mailing Address - Country:US
Mailing Address - Phone:334-413-1039
Mailing Address - Fax:
Practice Address - Street 1:100 QUAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:VALLEY GRANDE
Practice Address - State:AL
Practice Address - Zip Code:36703-1532
Practice Address - Country:US
Practice Address - Phone:334-413-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-171067163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse