Healthcare Provider Details

I. General information

NPI: 1053247635
Provider Name (Legal Business Name): AVA ANNMARIE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 E HOFFER ST
KOKOMO IN
46902-2474
US

IV. Provider business mailing address

860 HARVEST DR APT F
KOKOMO IN
46901-7853
US

V. Phone/Fax

Practice location:
  • Phone: 764-419-0411
  • Fax: 800-727-9914
Mailing address:
  • Phone: 765-419-0411
  • Fax: 800-727-9914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: