Provider Demographics
NPI:1528642238
Name:DAVIS, KILEY PAYNE (PA)
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:PAYNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14306 WINDY CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1786
Mailing Address - Country:US
Mailing Address - Phone:281-782-6504
Mailing Address - Fax:
Practice Address - Street 1:1300 ROLLINGBROOK DR STE 508
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3863
Practice Address - Country:US
Practice Address - Phone:281-837-6463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-09
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14996363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant