Provider Demographics
NPI:1134795867
Name:DAVIS, KAREN MICHELLE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MICHELLE
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 1:7333 PINE FOREST RD LOT 24
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-3949
Mailing Address - Country:US
Mailing Address - Phone:850-760-7612
Mailing Address - Fax:850-497-6164
Practice Address - Street 1:7333 PINE FOREST RD LOT 24
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-3949
Practice Address - Country:US
Practice Address - Phone:850-760-7612
Practice Address - Fax:850-497-6164
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL237625372600000X, 376J00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker