Healthcare Provider Details

I. General information

NPI: 1215616198
Provider Name (Legal Business Name): KYLE DAVIS M.A., CDC 1, BHA III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 KANAKANAK ROAD
DILLINGHAM AK
99576
US

IV. Provider business mailing address

PO BOX 931
DILLINGHAM AK
99576-0931
US

V. Phone/Fax

Practice location:
  • Phone: 907-842-1230
  • Fax:
Mailing address:
  • Phone: 907-843-9048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: