Provider Demographics
NPI:1093824039
Name:DAVIS, ANN M (PHD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:M
Other - Last Name:MCGRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW
Mailing Address - Street 2:4070 DELP MAIL STOP 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-7816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:2026 MILLER MAIL STOP 4004
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6301
Practice Address - Fax:913-588-6319
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1117103T00000X
MO2012018176103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
680013642OtherRAILROAD MEDICARE
KS100402530AMedicaid
MO31435018OtherBCBS KANSAS CITY
MO495338402Medicaid
032B097AMedicare ID - Type Unspecified
MO31435018OtherBCBS KANSAS CITY