Healthcare Provider Details

I. General information

NPI: 1184262941
Provider Name (Legal Business Name): MICHELE LINNETTE DAVIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3135 PROSPECT AVE
KANSAS CITY MO
64128-1552
US

IV. Provider business mailing address

3135 PROSPECT AVE
KANSAS CITY MO
64128-1552
US

V. Phone/Fax

Practice location:
  • Phone: 816-209-1237
  • Fax: 816-209-1238
Mailing address:
  • Phone: 816-209-1237
  • Fax: 816-577-5091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020021045
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-79143-092
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number79143
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: