Provider Demographics
NPI:1528609120
Name:DAVIS, KATHY
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11565 OLD VIRGINIA RD APT 329
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5876
Mailing Address - Country:US
Mailing Address - Phone:775-813-8928
Mailing Address - Fax:
Practice Address - Street 1:11565 OLD VIRGINIA RD APT 329
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5876
Practice Address - Country:US
Practice Address - Phone:775-813-8928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide