Provider Demographics
NPI:1497027502
Name:DAVIS, KEVIN D (RN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-2135
Mailing Address - Country:US
Mailing Address - Phone:917-361-3073
Mailing Address - Fax:
Practice Address - Street 1:44 SLEEPY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-2135
Practice Address - Country:US
Practice Address - Phone:917-361-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-04
Last Update Date:2012-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY651600163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse