Healthcare Provider Details

I. General information

NPI: 1083506471
Provider Name (Legal Business Name): KENYATT RENEE DAVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S ALVARADO ST
LOS ANGELES CA
90006-4110
US

IV. Provider business mailing address

6348 N MILWAUKEE AVE # 390
CHICAGO IL
60646-3728
US

V. Phone/Fax

Practice location:
  • Phone: 847-235-6130
  • Fax: 847-235-6135
Mailing address:
  • Phone: 847-235-6130
  • Fax: 847-235-6135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95035164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: