Provider Demographics
NPI:1679294342
Name:DAVIS, KEIMA SHEREI (IBCLC)
Entity Type:Individual
Prefix:
First Name:KEIMA
Middle Name:SHEREI
Last Name:DAVIS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42561
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-0010
Mailing Address - Country:US
Mailing Address - Phone:704-649-7515
Mailing Address - Fax:
Practice Address - Street 1:3841 MOSSCROFT LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-0919
Practice Address - Country:US
Practice Address - Phone:704-649-7515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC252Y00000X
172V00000X
NCL-307162174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health Worker