Provider Demographics
NPI:1033557012
Name:DAVIS-DARBY, KRISHAWN
Entity Type:Individual
Prefix:
First Name:KRISHAWN
Middle Name:
Last Name:DAVIS-DARBY
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:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:OLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28368-0103
Mailing Address - Country:US
Mailing Address - Phone:919-498-1767
Mailing Address - Fax:
Practice Address - Street 1:5593 OLIVIA RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27332
Practice Address - Country:US
Practice Address - Phone:919-498-1767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program