Provider Demographics
NPI:1578136859
Name:MIDGETTE DAVIS, KENZIE (NP)
Entity Type:Individual
Prefix:
First Name:KENZIE
Middle Name:
Last Name:MIDGETTE DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 FIELD ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-8708
Mailing Address - Country:US
Mailing Address - Phone:252-531-0752
Mailing Address - Fax:
Practice Address - Street 1:800 MOYE BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4169
Practice Address - Country:US
Practice Address - Phone:252-752-7133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCDAVI-GFHQC363LP2300X
NC5014787363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care