Provider Demographics
NPI:1619652781
Name:DAVIS, KENDRA M
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 TARKTON SQ S UNIT 308
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-9582
Mailing Address - Country:US
Mailing Address - Phone:614-359-1889
Mailing Address - Fax:
Practice Address - Street 1:4747 ELLERY DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2543
Practice Address - Country:US
Practice Address - Phone:161-421-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care