Provider Demographics
NPI:1942517503
Name:DAVIS, KENYADA DESHAWN (BHRS)
Entity Type:Individual
Prefix:
First Name:KENYADA
Middle Name:DESHAWN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 NE 31ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-7622
Mailing Address - Country:US
Mailing Address - Phone:405-922-3129
Mailing Address - Fax:
Practice Address - Street 1:914 NE 31ST ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-7622
Practice Address - Country:US
Practice Address - Phone:405-922-3129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst