Provider Demographics
NPI:1225177710
Name:DAVIS, KENT L (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-2124
Mailing Address - Country:US
Mailing Address - Phone:859-987-6230
Mailing Address - Fax:859-987-0149
Practice Address - Street 1:274 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2124
Practice Address - Country:US
Practice Address - Phone:859-987-6230
Practice Address - Fax:859-987-0149
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AD8755223OtherDEA
AD8755223OtherDEA