Healthcare Provider Details

I. General information

NPI: 1457023020
Provider Name (Legal Business Name): KEVIN JAMAAL DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HOSPITAL DR
MADISON TN
37115-5030
US

IV. Provider business mailing address

505 CENTRAL AVE APT 422
WHITE PLAINS NY
10606-1543
US

V. Phone/Fax

Practice location:
  • Phone: 615-732-7671
  • Fax:
Mailing address:
  • Phone: 518-253-0733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number747212
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number747212-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: