Provider Demographics
NPI:1881247104
Name:DAVIS, KATHY DELOIS (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:DELOIS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:DELOIS
Other - Last Name:KING-DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3945 BRAXTON DR STE 2
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-6303
Mailing Address - Country:US
Mailing Address - Phone:281-636-6861
Mailing Address - Fax:
Practice Address - Street 1:3945 BRAXTON DR STE 2
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-6303
Practice Address - Country:US
Practice Address - Phone:281-636-6861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX629562164W00000X
TXAP133606363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse