Provider Demographics
NPI:1427543594
Name:DAVIS, TEVIN CHAVON
Entity Type:Individual
Prefix:MR
First Name:TEVIN
Middle Name:CHAVON
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 E MEXICO AVE APT 504
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4135
Mailing Address - Country:US
Mailing Address - Phone:386-254-9609
Mailing Address - Fax:
Practice Address - Street 1:4225 E MEXICO AVE APT 504
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4135
Practice Address - Country:US
Practice Address - Phone:386-254-9609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide