=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134795867
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN MICHELLE DAVIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2021
-----------------------------------------------------
Last Update Date | 06/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7333 PINE FOREST RD LOT 24
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32526-3949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-760-7612
-----------------------------------------------------
Fax | 850-497-6164
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7333 PINE FOREST RD LOT 24
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32526-3949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-760-7612
-----------------------------------------------------
Fax | 850-497-6164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 372600000X
-----------------------------------------------------
Taxonomy Name | Adult Companion
-----------------------------------------------------
License Number | 237625
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number | 237625
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | 237625
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------