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NPI Code Detail

MEDICARE: KARA DANIELLE DAVIS

MEDICARE: KARA DANIELLE DAVIS
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
1363L00000XNurse Practitioner3016170KY
2363LF0000XFamily Nurse Practitioner3016170KY

General Provider Information

NPI Number : 1760140107
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARA DANIELLE DAVIS
Provider Business Mailing Address
First Line : 12201 BLUEGRASS PKWY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2361
Country : US
Telephone Number : 502-568-7364
Fax Number : 502-568-7136
Provider Business Practice Location Address
First Line : 1120 CRISTLAND RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40214-4150
Country : US
Telephone Number : 502-367-0104
Fax Number : 502-368-5208
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2021
Last Update Date : 12/14/2021

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