Healthcare Provider Details

I. General information

NPI: 1760206734
Provider Name (Legal Business Name): KANNIKA MARIE DAVIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 COVINGTON PIKE
MEMPHIS TN
38128-8090
US

IV. Provider business mailing address

2860 COVINGTON PIKE
MEMPHIS TN
38128-8090
US

V. Phone/Fax

Practice location:
  • Phone: 901-252-6066
  • Fax: 901-384-0260
Mailing address:
  • Phone: 901-252-6066
  • Fax: 901-384-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberAPN0000034949
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: