Healthcare Provider Details

I. General information

NPI: 1407246986
Provider Name (Legal Business Name): TONIKA DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 PEABODY LN APT 4
LOUISVILLE KY
40218-1826
US

IV. Provider business mailing address

1929 PEABODY LN APT 4
LOUISVILLE KY
40218-1826
US

V. Phone/Fax

Practice location:
  • Phone: 502-544-3838
  • Fax:
Mailing address:
  • Phone: 502-544-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberPT000033188
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: