Provider Demographics
NPI:1619511383
Name:DAVIS, KENISHA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:KENISHA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 VAUXHALL PL
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-4667
Mailing Address - Country:US
Mailing Address - Phone:901-503-5313
Mailing Address - Fax:
Practice Address - Street 1:2944 N STAGE PLZ
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3705
Practice Address - Country:US
Practice Address - Phone:901-503-5313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN246971163W00000X, 163WC0400X
TN191170246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other