Provider Demographics
NPI:1861108656
Name:DAVIS, EPA KAMALO
Entity type:Individual
Prefix:
First Name:EPA
Middle Name:KAMALO
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 1:1729 YELLOW ROSE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-2031
Mailing Address - Country:US
Mailing Address - Phone:702-858-6122
Mailing Address - Fax:
Practice Address - Street 1:1729 YELLOW ROSE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-2031
Practice Address - Country:US
Practice Address - Phone:702-858-6122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide