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NPI Code Detail

MEDICARE: KAELYN DAVIS

MEDICARE:   KAELYN  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
1390200000XStudent in an Organized Health Care Education/Training Program
2363A00000XPhysician AssistantOK

General Provider Information

NPI Number : 1841053931
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAELYN DAVIS
Provider Business Mailing Address
First Line : 14809 WALNUT LN
Second Line :
City : CHOCTAW
State : OK
Zip : 73020-9040
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 700 NE 13TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73104-5004
Country : US
Telephone Number : 405-271-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2024
Last Update Date : 01/06/2026

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Directions to “ KAELYN DAVIS ” Practice Location

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