Healthcare Provider Details

I. General information

NPI: 1609618610
Provider Name (Legal Business Name): KAILEY DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2277 NW MILITARY HWY # 100
SAN ANTONIO TX
78213-1853
US

IV. Provider business mailing address

2277 NW MILITARY HWY # 100
SAN ANTONIO TX
78213-1853
US

V. Phone/Fax

Practice location:
  • Phone: 210-796-8602
  • Fax:
Mailing address:
  • Phone: 210-342-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1107083
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: