Active NPI
Kendrah Jordan Davis, BHPP
- Contractor
- Tucson, AZ
National Provider Identifier
1780934505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 2485644
- Practice address
- 3226 South Lakeside Drive
Tucson, AZ 85730 - Phone
- (520) 409-6566
- NPI assigned
- Sep 19, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 2485644 | AZ | Primary |
Addresses
Primary practice location
3226 South Lakeside Drive
Tucson, AZ 85730
Mailing address
3226 S. Lakeside Dr.
Tucson, AZ 85730
Phone (520) 409-6566
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2485644 | AZ | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348012800000",
"number": "1780934505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3226 S. LAKESIDE DR.",
"city": "TUCSON",
"state": "AZ",
"postal_code": "85730",
"telephone_number": "520-409-6566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3226 SOUTH LAKESIDE DRIVE",
"city": "TUCSON",
"state": "AZ",
"postal_code": "85730",
"telephone_number": "520-409-6566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "KENDRAH",
"middle_name": "JORDAN",
"name_prefix": "Mrs.",
"credential": "BHPP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-19",
"last_updated": "2012-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "AZ",
"license": "2485644",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.