Provider Demographics
NPI:1245380203
Name:DAVISON, KATHLEEN MARIE
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:DAVISON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KATHY
Other - Middle Name:M
Other - Last Name:DAVISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 PINENUT CT
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-6345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 PINENUT CT
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-6345
Practice Address - Country:US
Practice Address - Phone:925-439-9628
Practice Address - Fax:925-439-9639
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker