Provider Demographics
NPI:1942444948
Name:DAVIS, KENNETH SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:SCOTT
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1837 EDENSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1521
Mailing Address - Country:US
Mailing Address - Phone:502-458-8787
Mailing Address - Fax:502-458-8787
Practice Address - Street 1:1837 EDENSIDE AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1521
Practice Address - Country:US
Practice Address - Phone:502-458-8787
Practice Address - Fax:502-458-8787
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY293622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry