Provider Demographics
NPI:1437142627
Name:DAVIS, ANNE WETHERILL (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:WETHERILL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12221 HORTON
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209
Mailing Address - Country:US
Mailing Address - Phone:913-362-4411
Mailing Address - Fax:913-696-1955
Practice Address - Street 1:10918 ELM
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64134
Practice Address - Country:US
Practice Address - Phone:913-362-4411
Practice Address - Fax:913-696-1955
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-260212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100292390BMedicaid
KSP00319048Medicare PIN
G49518Medicare UPIN
KS100292390BMedicaid