Provider Demographics
NPI:1407239767
Name:DAVIS, MICHELLE LYNN (CNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10475 READING ROAD
Mailing Address - Street 2:STE 117
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2500
Mailing Address - Country:US
Mailing Address - Phone:513-559-1222
Mailing Address - Fax:513-559-1235
Practice Address - Street 1:10475 READING ROAD
Practice Address - Street 2:STE 117
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-2500
Practice Address - Country:US
Practice Address - Phone:513-559-1222
Practice Address - Fax:513-559-1235
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCREDENTIAL LICENSE363L00000X
KY3010585363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100439080Medicaid
KYK208050OtherMEDICARE PTAN