Kelly S Davis, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY35176 Issued in CA

Practice address

1795 W Broadway St # 125
Idaho Falls, ID 83402-3045

Phone

(414) 759-9678

NPI assigned

Dec 23, 2010

Last updated

Dec 30, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1293062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1306140827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1795 W BROADWAY ST # 125",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023045",
            "telephone_number": "414-759-9678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1795 W BROADWAY ST # 125",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023045",
            "telephone_number": "414-759-9678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "KELLY",
        "middle_name": "S",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-23",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "ID",
            "license": "PSY-203118",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY35176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James R Davis, OD
• Jeffrey Davis, LMSW
• Jodi Lyn Davis, LMSW
• Jordan Davis
• Kathryn Davis
• Kent W. Davis, MD
• Kirsten A Davis, LMP
• Lauren Ashley Davis, DMD
• Mercedes Davis
• Michael Davis

• Clinical Psychologist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Clinical Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.