Provider Demographics
NPI:1518285618
Name:DAVIS, KEELY E (RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:KEELY
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 MATTHEW DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-4638
Mailing Address - Country:US
Mailing Address - Phone:361-244-2846
Mailing Address - Fax:
Practice Address - Street 1:749 MATTHEW DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-4638
Practice Address - Country:US
Practice Address - Phone:361-244-2846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80447133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered