Healthcare Provider Details

I. General information

NPI: 1902734882
Provider Name (Legal Business Name): GRACE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13213 W 131ST ST
OVERLAND PARK KS
66213-2345
US

IV. Provider business mailing address

13213 W 131ST ST
OVERLAND PARK KS
66213-2345
US

V. Phone/Fax

Practice location:
  • Phone: 913-475-7173
  • Fax:
Mailing address:
  • Phone: 913-475-7173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-4207135
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: