MEDICARE: ELIZABETH 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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1952047136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH DAVIS

Provider Business Mailing Address
First Line	:	11050 W 192ND PL
Second Line	:
City	:	SPRING HILL
State	:	KS
Zip	:	66083-7529
Country	:	US
Telephone Number	:	913-317-6315
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 HUTTON RD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-4436
Country	:	US
Telephone Number	:	816-478-4200
Fax Number	:

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

Provider Enumeration Date	:	05/10/2022
Last Update Date	:	10/21/2022

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