Basic Information
| Provider Information | |||||||||
| NPI: | 1720146467 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | KAYE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2326 STUTZ DR UNIT 116 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752356540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733688845 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3998 FAIR RIDGE DR | ||||||||
| Address2: | STE 320 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220332907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032959360 | ||||||||
| FaxNumber: | 7032959369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 10/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0101256976 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | T0191 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 036089197 | 05 | IL | MEDICAID | P00154997 | 01 | IL | RAILROAD MEDICARE | OTHER | 04932277 | 01 | IL | BCBS | OTHER |