Provider Demographics
NPI:1902279524
Name:DAVIS, KELLIE CHEERI
Entity Type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:CHEERI
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 EXCHANGE PL STE 114
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2510
Mailing Address - Country:US
Mailing Address - Phone:337-291-2815
Mailing Address - Fax:337-291-2817
Practice Address - Street 1:114 EXCHANGE PL STE 114
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503
Practice Address - Country:US
Practice Address - Phone:337-291-2815
Practice Address - Fax:337-291-2817
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator