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General NPI Number Information
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NPI Number | 1679294342
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Entity Type | Individual
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Provider Name | KEIMA SHEREI DAVIS IBCLC
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Gender | Female
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 3841 MOSSCROFT LN
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City | CHARLOTTE
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State | NC
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Zip | 28215-0919
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Country | US
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Telephone | 704-649-7515
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 42561
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City | CHARLOTTE
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State | NC
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Zip | 28215-0010
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Country | US
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Telephone | 704-649-7515
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | L-307162
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License Number State | NC
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