Active NPI
Walter Etchelles Davis, M.D
- Specialist
- Boone, NC
National Provider Identifier
1487757977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 15051
- Practice address
- 184 Virginia Street
Boone, NC 28607 - Phone
- (828) 262-4332
- Fax
- (828) 265-5514
- NPI assigned
- Sep 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 15051 | NC | Primary |
Addresses
Primary practice location
184 Virginia Street
Boone, NC 28607
Mailing address
266 River Knoll PL
Jefferson, NC 28640-9392
Phone (336) 982-3776
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0211X | Other | NC | BLUE CROSS BLUE SHIELD NC |
| 890211X | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3523 | NC | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Watauga Medical Center, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Watauga Medical Center
- Psychiatry Physician
- Boone, NC
- NPI 1407921802
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487757977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "266 RIVER KNOLL PL",
"city": "JEFFERSON",
"state": "NC",
"postal_code": "286409392",
"telephone_number": "336-982-3776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "184 VIRGINIA STREET",
"city": "BOONE",
"state": "NC",
"postal_code": "28607",
"telephone_number": "828-262-4332",
"fax_number": "828-265-5514"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "WALTER",
"middle_name": "ETCHELLES",
"credential": "M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NC",
"license": "15051",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD NC",
"identifier": "0211X",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "890211X",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boone, NC
- Paul Joseph Daoust Jr., L.P.C.
- David Crank DDS PA (High Country Dentistry)
- Claire L Davis, MSAT, LAT, ATC
- Meghan Alexandria Davis
- Savannah Sheets Davis, OD
- Daymark Recovery Services Inc
- Daymark Recovery Services Inc
- Daymark Recovery Services Inc
- Juan Carlos De Virgiliis, MD
- Tyler Allease Deal, LPCA, NCC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.