Provider Demographics
NPI:1184224958
Name:DAVIS, KAYLA KOTHMANN
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:KOTHMANN
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 1:2410 DODSON AVE
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-8009
Mailing Address - Country:US
Mailing Address - Phone:830-775-6995
Mailing Address - Fax:
Practice Address - Street 1:2410 DODSON AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-8009
Practice Address - Country:US
Practice Address - Phone:830-775-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist