Provider Demographics
NPI:1427035344
Name:DAVIS, KATHLEEN ANNE (RN; NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN; NP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:HERR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:3129 WOODMONT DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-1454
Mailing Address - Country:US
Mailing Address - Phone:559-930-2518
Mailing Address - Fax:
Practice Address - Street 1:1241 E DYER RD STE 1451241E
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5611
Practice Address - Country:US
Practice Address - Phone:949-449-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP9457163WS0200X, 363LX0001X
CA336132163WW0101X
CA9457363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9457OtherNURSE PRACTITIONER LIC
CA336132OtherREGISTERED NURSE