Provider Demographics
NPI:1952915159
Name:DAVIS, PRECIOUS EBONY (CPS)
Entity Type:Individual
Prefix:MS
First Name:PRECIOUS
Middle Name:EBONY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CPS
Other - Prefix:MRS
Other - First Name:PRECIOUS
Other - Middle Name:EBONY
Other - Last Name:FLENORY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPS
Mailing Address - Street 1:312 SW GREENWICH DR STE 626
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4408
Mailing Address - Country:US
Mailing Address - Phone:913-602-0106
Mailing Address - Fax:816-537-8605
Practice Address - Street 1:1119 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66104-5945
Practice Address - Country:US
Practice Address - Phone:913-290-4110
Practice Address - Fax:816-537-8605
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist