Provider Demographics
NPI:1548046253
Name:DAVIS, KELLY HAYES (RN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:HAYES
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WILLOUGHBY LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-3526
Mailing Address - Country:US
Mailing Address - Phone:609-668-0854
Mailing Address - Fax:
Practice Address - Street 1:22 WILLOUGHBY LN
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08088-3526
Practice Address - Country:US
Practice Address - Phone:609-668-0854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10945100163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse