Individual
TAMMY JEANNE DAVISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CDE
Contact information
Practice address
2535 HUALAPAI MTN RD, STE C, KINGMAN, AZ 86401
(928) 415-0446
(928) 692-1323
Mailing address
4099 GEMSTONE AVE, KINGMAN, AZ 86401-7385
(928) 530-5430
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
875166
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
311096
—
AZ
01
—
Z168265
MEDICARE
AZ
Enumeration date
01/07/2008
Last updated
07/27/2015
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