MEDICARE: KATHLEEN L DAVIS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	ARNP3275952	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154805877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN L DAVIS NP

Provider Business Mailing Address
First Line	:	P.O. BOX 9218
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33468-9218
Country	:	US
Telephone Number	:	561-263-7010
Fax Number	:

Provider Business Practice Location Address
First Line	:	5430 MILITARY TRAIL
Second Line	:	STE 64
City	:	JUPITER
State	:	FL
Zip	:	33458-2873
Country	:	US
Telephone Number	:	561-263-7010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2018
Last Update Date	:	11/24/2020

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