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General NPI Number Information
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NPI Number | 1033878269
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Entity Type | Individual
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Provider Name | KELLY RAE DAVEY
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Gender | Female
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Dates
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Enumeration Date | 12/15/2021
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 2139 AUBURN AVE
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City | CINCINNATI
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State | OH
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Zip | 45219-2906
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Country | US
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Telephone | 859-803-7299
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Fax |
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Provider Business Mailing Address
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Address Line | 11183 WAR ADMIRAL DR
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City | UNION
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State | KY
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Zip | 41091-2503
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Country | US
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Telephone | 859-803-7299
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 0030826
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License Number State | OH
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