Provider Demographics
NPI:1235900770
Name:DAVIS, KIERRA KRISTINA
Entity Type:Individual
Prefix:
First Name:KIERRA
Middle Name:KRISTINA
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 1:3169 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-4971
Mailing Address - Country:US
Mailing Address - Phone:424-305-9954
Mailing Address - Fax:
Practice Address - Street 1:3169 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-4971
Practice Address - Country:US
Practice Address - Phone:424-305-9954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider