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General NPI Number Information
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NPI Number | 1174181903
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Entity Type | Individual
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Provider Name | KATHERINE RENEE DAVIS DNP
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Gender | Female
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Dates
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Enumeration Date | 06/05/2019
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 3433 W MADISON ST
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City | CHICAGO
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State | IL
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Zip | 60624-2895
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Country | US
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Telephone | 773-242-2299
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Fax | 773-830-1920
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Provider Business Mailing Address
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Address Line | PO BOX 746715
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City | ATLANTA
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State | GA
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Zip | 30374-6715
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Country | US
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Telephone | 773-242-2299
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Fax | 773-830-1920
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209.019181
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11400-33
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License Number State | WI
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