Provider Demographics
NPI:1376272856
Name:DAVIS, MONICA REBEKAH (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:REBEKAH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 E MURDOCK ST STE 500
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3007
Mailing Address - Country:US
Mailing Address - Phone:316-962-2080
Mailing Address - Fax:316-962-2079
Practice Address - Street 1:3243 E MURDOCK ST STE 500
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3007
Practice Address - Country:US
Practice Address - Phone:316-962-2080
Practice Address - Fax:316-962-2079
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5379524363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics