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KELLY DAVIS CHW

>> Community Health Worker >> Other Service Providers

Registrant NPI Number: 1386220523

Individual Registrant:
 KELLY  DAVIS CHW
Gender: F
Not Sole Proprietor

Location and contact information for practice:
54771 MCKENZIE HWY  BLUE RIVER, OR 97413-9790 US
Tel: 541-822-3341  Fax: 541-822-3836

Contact information for business:
PO BOX 546  GRESHAM, OR 97030-0132 US
Tel: 541-782-8242  Fax: --

Registration Information:
NPI: 1386220523
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y172V00000XOther Service Providers
Community Health Worker

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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