Provider Demographics
NPI:1730900036
Name:DAVIS, KRISTIN ELIZABETH (RN, PHN, ACN)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELIZABETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN, PHN, ACN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4023 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7520
Mailing Address - Country:US
Mailing Address - Phone:831-818-3460
Mailing Address - Fax:
Practice Address - Street 1:4023 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7520
Practice Address - Country:US
Practice Address - Phone:831-818-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA845145163WP0200X
CA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No163WP0200XNursing Service ProvidersRegistered NursePediatrics