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NPI Code Detail

MEDICARE: MS. PRECIOUS EBONY DAVIS CPS

MEDICARE:  MS. PRECIOUS EBONY DAVIS  CPS
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
1175T00000XPeer SpecialistKS

General Provider Information

NPI Number : 1952915159
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PRECIOUS EBONY DAVIS CPS
Provider Business Mailing Address
First Line : 312 SW GREENWICH DR STE 626
Second Line :
City : LEES SUMMIT
State : MO
Zip : 64082-4408
Country : US
Telephone Number : 913-602-0106
Fax Number : 816-537-8605
Provider Business Practice Location Address
First Line : 1119 RICHMOND AVE
Second Line :
City : KANSAS CITY
State : KS
Zip : 66104-5945
Country : US
Telephone Number : 913-290-4110
Fax Number : 816-537-8605
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2020
Last Update Date : 09/04/2020

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Directions to “ MS. PRECIOUS EBONY DAVIS CPS” Practice Location

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