MEDICARE: KATHLEEN SUSAN DAVIS MSN, AGPCNP-C

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	363L00000X	Nurse Practitioner	1100338	TX
2	163W00000X	Registered Nurse	0000222645	TN

General Provider Information

NPI Number	:	1346832904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN SUSAN DAVIS MSN, AGPCNP-C

Provider Business Mailing Address
First Line	:	6560 FANNIN ST STE 2200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2715
Country	:	US
Telephone Number	:	678-852-2642
Fax Number	:

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST STE 2200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2715
Country	:	US
Telephone Number	:	678-852-2642
Fax Number	:

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

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	03/04/2024

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