MEDICARE: KINDRA ROSE DAVIS APN-NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN.0172190	CO
2	363LF0000X	Family Nurse Practitioner	APN.0992854-NP	CO

General Provider Information

NPI Number	:	1689118440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KINDRA ROSE DAVIS APN-NP

Provider Business Mailing Address
First Line	:	303 COLLAND DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4205
Country	:	US
Telephone Number	:	970-821-3031
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 COLLAND DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4205
Country	:	US
Telephone Number	:	970-821-3525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2016
Last Update Date	:	03/09/2017

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