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NPI Code Detail

MEDICARE: KYLE DAVIS SCM

MEDICARE: KYLE DAVIS SCM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1170300000XGenetic Counselor (M.S.)

General Provider Information

NPI Number : 1063870178
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE DAVIS SCM
Provider Business Mailing Address
First Line : 2677 E PARLEYS WAY
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84109-1617
Country : US
Telephone Number : 801-931-6191
Fax Number :
Provider Business Practice Location Address
First Line : 2677 E PARLEYS WAY
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84109-1617
Country : US
Telephone Number : 801-931-6191
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2016
Last Update Date : 02/03/2016

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