Healthcare Provider Details

I. General information

NPI: 1245636703
Provider Name (Legal Business Name): MS. PARAN KATHLEEN DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2014
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 SW MICHIGAN ST
LAKE CITY FL
32025-0440
US

IV. Provider business mailing address

4300 SW 13TH ST
GAINESVILLE FL
32608-4006
US

V. Phone/Fax

Practice location:
  • Phone: 386-487-0800
  • Fax:
Mailing address:
  • Phone: 352-374-5600
  • Fax: 352-244-2741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: