Healthcare Provider Details

I. General information

NPI: 1457701419
Provider Name (Legal Business Name): KELSEY M DAVIS-HUMES D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY M DAVIS D.O

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E SIGLER AVE STE A
MEMPHIS MO
63555-1726
US

IV. Provider business mailing address

450 E SIGLER AVE STE A
MEMPHIS MO
63555-1726
US

V. Phone/Fax

Practice location:
  • Phone: 660-465-2828
  • Fax: 660-465-2956
Mailing address:
  • Phone: 660-465-8513
  • Fax: 660-465-2956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.069458
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number201734707
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: