Provider Demographics
NPI:1598142028
Name:DAVIS, KRISTIN (APN)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:D
Other - Last Name:CLEAVINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 NE SAINT LUKES BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-6001
Mailing Address - Country:US
Mailing Address - Phone:816-347-5100
Mailing Address - Fax:816-347-5136
Practice Address - Street 1:20 NE SAINT LUKES BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6001
Practice Address - Country:US
Practice Address - Phone:816-347-5100
Practice Address - Fax:816-347-5136
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015005065363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner