Healthcare Provider Details

I. General information

NPI: 1174083919
Provider Name (Legal Business Name): KIRSTEN LYN DAVIS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 BELPAR ST NW
CANTON OH
44718-3603
US

IV. Provider business mailing address

4875 HIGBEE AVE NW
CANTON OH
44718-2566
US

V. Phone/Fax

Practice location:
  • Phone: 330-492-9200
  • Fax:
Mailing address:
  • Phone: 330-492-3345
  • Fax: 330-491-9758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2018080195
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: