Provider Demographics
NPI:1265098404
Name:DAVIS, KEIANA CASSANDRA (REGISTERED NURSE BSN)
Entity type:Individual
Prefix:
First Name:KEIANA
Middle Name:CASSANDRA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:REGISTERED NURSE BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 LEASURE DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8000
Mailing Address - Country:US
Mailing Address - Phone:142-184-4722
Mailing Address - Fax:
Practice Address - Street 1:199 LEASURE DR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8000
Practice Address - Country:US
Practice Address - Phone:614-218-4472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2024-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN522043163W00000X
DCRN500016856163W00000X
MDR256363163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse