Healthcare Provider Details

I. General information

NPI: 1528330867
Provider Name (Legal Business Name): KAI A DAVILA REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 MEETING ST
DULUTH GA
30096-6368
US

IV. Provider business mailing address

3875 MEETING ST
DULUTH GA
30096-6368
US

V. Phone/Fax

Practice location:
  • Phone: 917-348-2800
  • Fax: 917-348-2800
Mailing address:
  • Phone: 917-348-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN286605
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number611634-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: