MEDICARE: KATHY DELOIS DAVIS NURSE PRACTITIONER

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	164W00000X	Licensed Practical Nurse	629562	TX
2	363LF0000X	Family Nurse Practitioner	AP133606	TX

General Provider Information

NPI Number	:	1881247104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY DELOIS DAVIS NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	3945 BRAXTON DR STE 2
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-6303
Country	:	US
Telephone Number	:	281-636-6861
Fax Number	:

Provider Business Practice Location Address
First Line	:	3945 BRAXTON DR STE 2
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-6303
Country	:	US
Telephone Number	:	281-636-6861
Fax Number	:

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

Provider Enumeration Date	:	07/17/2019
Last Update Date	:	07/28/2020

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