MEDICARE: KATHERINE DANIELLE DAVIS

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	1041C0700X	Clinical Social Worker	256546	KY

General Provider Information

NPI Number	:	1386349728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE DANIELLE DAVIS

Provider Business Mailing Address
First Line	:	1079 MILLER VALLEY RD
Second Line	:
City	:	ELKTON
State	:	KY
Zip	:	42220-7903
Country	:	US
Telephone Number	:	270-604-3202
Fax Number	:

Provider Business Practice Location Address
First Line	:	1079 MILLER VALLEY RD
Second Line	:
City	:	ELKTON
State	:	KY
Zip	:	42220-7903
Country	:	US
Telephone Number	:	270-604-3202
Fax Number	:

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

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	04/04/2023

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Directions to “ KATHERINE DANIELLE DAVIS ” Practice Location

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