=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093195729
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAILEY DAVIS NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2015
-----------------------------------------------------
Last Update Date | 03/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 HOSPITAL DR
-----------------------------------------------------
City | WETUMPKA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36092-1626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-567-5626
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 355 BUCK RUN RD
-----------------------------------------------------
City | WETUMPKA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36093-2643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-328-1454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1-126972
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------