Provider Demographics
NPI:1073592366
Name:DAVIS, KARI A (APRN)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:A
Other - Last Name:WADDINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:40 MANSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2018
Mailing Address - Country:US
Mailing Address - Phone:860-450-7456
Mailing Address - Fax:860-450-0213
Practice Address - Street 1:40 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2018
Practice Address - Country:US
Practice Address - Phone:860-450-7471
Practice Address - Fax:860-450-0213
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002798363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008002684Medicaid
CTP76780Medicare UPIN
CO5000000969Medicare ID - Type Unspecified