MEDICARE: KAILEY DAVIS NP

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	363LF0000X	Family Nurse Practitioner	1-126972	AL

General Provider Information

NPI Number	:	1093195729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILEY DAVIS NP

Provider Business Mailing Address
First Line	:	355 BUCK RUN RD
Second Line	:
City	:	WETUMPKA
State	:	AL
Zip	:	36093-2643
Country	:	US
Telephone Number	:	334-328-1454
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 HOSPITAL DR
Second Line	:
City	:	WETUMPKA
State	:	AL
Zip	:	36092-1626
Country	:	US
Telephone Number	:	334-567-5626
Fax Number	:

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

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	03/16/2022

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Directions to “ KAILEY DAVIS NP” Practice Location

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