Healthcare Provider Details

I. General information

NPI: 1700721792
Provider Name (Legal Business Name): KELLY MARIE DAVIS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 S 1470 E
SAINT GEORGE UT
84790-1763
US

IV. Provider business mailing address

2647 E WAKE FOREST LN
SAINT GEORGE UT
84790-2387
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-5900
  • Fax:
Mailing address:
  • Phone: 336-689-4866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number14214592-2504
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: