Provider Demographics
NPI:1972019925
Name:DAVIS, KEVIN K JR (PA-C)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:K
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2900 12TH AVE N SAINT VINCENT HEART INSTITUTE
Mailing Address - Street 2:SUITE 204E
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101
Mailing Address - Country:US
Mailing Address - Phone:406-237-3690
Mailing Address - Fax:406-237-5010
Practice Address - Street 1:2900 12TH AVE N SAINT VINCENT HEART INSTITUTE
Practice Address - Street 2:SUITE 204E
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101
Practice Address - Country:US
Practice Address - Phone:406-237-5001
Practice Address - Fax:406-237-5010
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT60686363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant