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General NPI Number Information
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NPI Number | 1093751778
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Entity Type | Individual
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Provider Name | KATHLEEN M DAVIS FNP
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Gender | Female
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 401 EAST NODAWAY
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City | OREGON
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State | MO
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Zip | 64473-9689
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Country | US
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Telephone | 660-446-3307
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Fax | 660-446-3302
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Provider Business Mailing Address
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Address Line | 401 EAST NODAWAY
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City | OREGON
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State | MO
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Zip | 64473-9689
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Country | US
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Telephone | 660-446-3307
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Fax | 660-446-3302
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 140311
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License Number State | MO
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