Healthcare Provider Details

I. General information

NPI: 1467728089
Provider Name (Legal Business Name): CRYSTAL DAWN DAVISON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 NE TUDOR RD
LEES SUMMIT MO
64086-5696
US

IV. Provider business mailing address

5101 COLLEGE BLVD
LEAWOOD KS
66211-1614
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-5522
  • Fax: 816-524-4798
Mailing address:
  • Phone: 816-812-1682
  • Fax: 816-524-4798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-77807
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012006269
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: