Provider Demographics
NPI:1366856320
Name:DAVIS, KRISTINA ANNE (DNP)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:ANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:467 CANE MILL CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:PATRICK
Mailing Address - State:SC
Mailing Address - Zip Code:29584-4537
Mailing Address - Country:US
Mailing Address - Phone:843-287-1234
Mailing Address - Fax:
Practice Address - Street 1:467 CANE MILL CROSSING RD
Practice Address - Street 2:
Practice Address - City:PATRICK
Practice Address - State:SC
Practice Address - Zip Code:29584-4537
Practice Address - Country:US
Practice Address - Phone:843-287-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC109073163WE0003X
WY28416.1333363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency