Individual
MISS JACALYN VANNESSA DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
KCSA
Contact information
Practice address
709 E MADISON ST, LOUISVILLE, KY 40202-1629
(502) 377-0628
Mailing address
709 E MADISON ST, LOUISVILLE, KY 40202-1629
(502) 377-0628
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
KSCA176
KY
Other
Enumeration date
09/29/2008
Last updated
09/29/2008
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