Provider Demographics
NPI:1326011768
Name:DAVIS, KAREN RAE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:RAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 W BROKEN BOW DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-2073
Mailing Address - Country:US
Mailing Address - Phone:719-647-1211
Mailing Address - Fax:719-553-1104
Practice Address - Street 1:4112 OUTLOOK BLVD
Practice Address - Street 2:ROOM 342
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1667
Practice Address - Country:US
Practice Address - Phone:719-553-1021
Practice Address - Fax:719-553-1104
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN 81812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner