Healthcare Provider Details

I. General information

NPI: 1578136859
Provider Name (Legal Business Name): KENZIE MIDGETTE DAVIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MOYE BLVD
GREENVILLE NC
27834-4169
US

IV. Provider business mailing address

208 FIELD ST
GREENVILLE NC
27858-8708
US

V. Phone/Fax

Practice location:
  • Phone: 252-752-7133
  • Fax:
Mailing address:
  • Phone: 252-531-0752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberDAVI-GFHQC
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5014787
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: