Individual
DE' ANDRA DESTHEENIA DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
504 HOPKINSVILLE ST, GREENVILLE, KY 42345-1104
(270) 338-6488
(270) 338-7868
Mailing address
480 HOPKINSVILLE ST, GREENVILLE, KY 42345-1124
(270) 338-5777
(270) 338-5765
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
49716
KY
208000000X
Pediatrics Physician
MD.205560
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100444110
—
KY
Enumeration date
12/22/2011
Last updated
12/20/2019
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