MEDICARE: DR. KELLIE ANNE DAVIDSON AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237600000X	Audiologist-Hearing Aid Fitter	A-192	NV
2	237600000X	Audiologist-Hearing Aid Fitter	192	NV

General Provider Information

NPI Number	:	1013195692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLIE ANNE DAVIDSON AU.D.

Provider Business Mailing Address
First Line	:	2920 N GREEN VALLEY PKWY
Second Line	:	BLDG 3 SUITE 321
City	:	HENDERSON
State	:	NV
Zip	:	89014-0406
Country	:	US
Telephone Number	:	702-990-0921
Fax Number	:	702-990-0922

Provider Business Practice Location Address
First Line	:	2920 N GREEN VALLEY PKWY
Second Line	:	BLDG 3 SUITE 321
City	:	HENDERSON
State	:	NV
Zip	:	89014-0406
Country	:	US
Telephone Number	:	702-990-0921
Fax Number	:	702-990-0922

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	02/05/2008

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