MEDICARE: MRS. KRISTY LYNN DAVIS LMFT

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
1	106H00000X	Marriage & Family Therapist	129582	CA
2	106H00000X	Marriage & Family Therapist	TPMF602	FL
3	106H00000X	Marriage & Family Therapist	2774	TN

General Provider Information

NPI Number	:	1285801365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTY LYNN DAVIS LMFT

Provider Business Mailing Address
First Line	:	PO BOX 746725
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6725
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:

Provider Business Practice Location Address
First Line	:	1019 OXFORD HILLS DR
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37803-1944
Country	:	US
Telephone Number	:	707-803-1657
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	03/11/2026

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