Provider Demographics
NPI:1285495549
Name:DAVIS, KACEY ANN (BS,CD, SBD, CLC, CPS)
Entity type:Individual
Prefix:
First Name:KACEY
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BS,CD, SBD, CLC, CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 COUNTY ROAD 601
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-7793
Mailing Address - Country:US
Mailing Address - Phone:573-576-5280
Mailing Address - Fax:
Practice Address - Street 1:1145 COUNTY ROAD 601
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-7793
Practice Address - Country:US
Practice Address - Phone:573-576-5280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula