MEDICARE: KIMBERLY ANNE DAVIS LCSW

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	1041C0700X	Clinical Social Worker	254821	KY

General Provider Information

NPI Number	:	1184249617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANNE DAVIS LCSW

Provider Business Mailing Address
First Line	:	961 BEASLEY ST STE 170
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-4120
Country	:	US
Telephone Number	:	859-226-5022
Fax Number	:

Provider Business Practice Location Address
First Line	:	961 BEASLEY ST STE 170
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-4120
Country	:	US
Telephone Number	:	859-226-5022
Fax Number	:

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

Provider Enumeration Date	:	06/10/2020
Last Update Date	:	06/10/2020

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Directions to “ KIMBERLY ANNE DAVIS LCSW” Practice Location

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