Individual
KELLIE MARY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9254 EMILY CIR, LAKE WORTH, FL 33467-3600
(561) 309-1631
Mailing address
9254 EMILY CIR, LAKE WORTH, FL 33467-3600
(561) 309-1631
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
3252282
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3252282
REGISTERED NURSE
FL
Enumeration date
12/17/2020
Last updated
12/17/2020
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