Provider Demographics
NPI:1003356080
Name:DAVIS, KEAVE R (LPN)
Entity Type:Individual
Prefix:MR
First Name:KEAVE
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 NORTH COLUMBUS AVE
Mailing Address - Street 2:APT 12D
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550
Mailing Address - Country:US
Mailing Address - Phone:914-803-3619
Mailing Address - Fax:
Practice Address - Street 1:23 N COLUMBUS AVE
Practice Address - Street 2:APT 12D
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1043
Practice Address - Country:US
Practice Address - Phone:914-803-3619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328047-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse