Individual
KELLY DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
6326 CONSTITUTION DR, FORT WAYNE, IN 46804-1518
(260) 969-6200
Mailing address
4107 ROCKY KNOLL CT, FORT WAYNE, IN 46809-9534
(260) 466-8908
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71010315A
IN
Other
Enumeration date
08/31/2020
Last updated
08/31/2020
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