Provider Demographics
NPI:1013195692
Name:DAVIDSON, KELLIE ANNE (AUD)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:ANNE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 N GREEN VALLEY PKWY
Mailing Address - Street 2:BLDG 3 SUITE 321
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-0406
Mailing Address - Country:US
Mailing Address - Phone:702-990-0921
Mailing Address - Fax:702-990-0922
Practice Address - Street 1:2920 N GREEN VALLEY PKWY
Practice Address - Street 2:BLDG 3 SUITE 321
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0406
Practice Address - Country:US
Practice Address - Phone:702-990-0921
Practice Address - Fax:702-990-0922
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-192237600000X
NV192237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter