Healthcare Provider Details

I. General information

NPI: 1285323147
Provider Name (Legal Business Name): KEESHA ANGELEA DAVIS APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 OAKDALE RD
MODESTO CA
95355-3357
US

IV. Provider business mailing address

2700 MARINA DR APT 112
MODESTO CA
95355-2269
US

V. Phone/Fax

Practice location:
  • Phone: 209-557-6200
  • Fax:
Mailing address:
  • Phone: 725-296-2496
  • Fax: 801-845-9782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number866451
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95033187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: