Provider Demographics
NPI:1073256038
Name:DAVIS, KENYSHA MELISSA
Entity Type:Individual
Prefix:
First Name:KENYSHA
Middle Name:MELISSA
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 1:7898 CANTWELL RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1250
Mailing Address - Country:US
Mailing Address - Phone:443-414-8607
Mailing Address - Fax:
Practice Address - Street 1:10455 MILL RUN CIR
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4208
Practice Address - Country:US
Practice Address - Phone:410-581-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR178563163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management