Provider Demographics
NPI:1861598427
Name:DAVIS, KYRA L (LMP)
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 LASSO DR
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-8994
Mailing Address - Country:US
Mailing Address - Phone:509-670-6327
Mailing Address - Fax:509-888-8001
Practice Address - Street 1:11 SPOKANE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6132
Practice Address - Country:US
Practice Address - Phone:509-670-6327
Practice Address - Fax:509-888-8001
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020262174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist