MEDICARE: KALIYAH 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	171M00000X	Case Manager/Care Coordinator		OK

General Provider Information

NPI Number	:	1992236533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALIYAH DAVIS

Provider Business Mailing Address
First Line	:	4513 N KENOSHA AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74106-1313
Country	:	US
Telephone Number	:	918-704-0372
Fax Number	:

Provider Business Practice Location Address
First Line	:	4513 N KENOSHA AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74106-1313
Country	:	US
Telephone Number	:	918-704-0372
Fax Number	:

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

Provider Enumeration Date	:	03/24/2017
Last Update Date	:	03/24/2017

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Directions to “ KALIYAH DAVIS ” Practice Location

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