Healthcare Provider Details

I. General information

NPI: 1508748682
Provider Name (Legal Business Name): KEVIN DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7243 EASTLAWN DR
CINCINNATI OH
45237-3515
US

IV. Provider business mailing address

7243 EASTLAWN DR
CINCINNATI OH
45237-3515
US

V. Phone/Fax

Practice location:
  • Phone: 513-740-1001
  • Fax:
Mailing address:
  • Phone: 513-740-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: