Healthcare Provider Details

I. General information

NPI: 1700337441
Provider Name (Legal Business Name): KIARA COURTNEY DAVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 STATE RD
PLYMOUTH MA
02360-5133
US

IV. Provider business mailing address

67 BRIGHAM ST
NEW BEDFORD MA
02740-2211
US

V. Phone/Fax

Practice location:
  • Phone: 508-224-7701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2307849
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: