MEDICARE: MRS. ELLYN KATHRYN DAVIS PA-C

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	363A00000X	Physician Assistant	50.007498RX	OH

General Provider Information

NPI Number	:	1780331918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELLYN KATHRYN DAVIS PA-C

Provider Business Mailing Address
First Line	:	7794 5 MILE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-2368
Country	:	US
Telephone Number	:	513-246-2300
Fax Number	:	513-246-7449

Provider Business Practice Location Address
First Line	:	7794 5 MILE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-2368
Country	:	US
Telephone Number	:	513-246-2300
Fax Number	:	513-246-7449

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

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	04/15/2026

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