Healthcare Provider Details

I. General information

NPI: 1720915531
Provider Name (Legal Business Name): KAILENE ALEXIS DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 STATE ST
SPRINGFIELD MA
01103-1985
US

IV. Provider business mailing address

1328 PAGE BLVD
SPRINGFIELD MA
01104-1747
US

V. Phone/Fax

Practice location:
  • Phone: 413-307-7797
  • Fax:
Mailing address:
  • Phone: 413-307-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: