Provider Demographics
NPI:1639934193
Name:DAVIS, KORTNI MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:KORTNI
Middle Name:MICHELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6607 BUTTERCUP DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-5718
Mailing Address - Country:US
Mailing Address - Phone:307-286-6894
Mailing Address - Fax:
Practice Address - Street 1:2604 HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1506
Practice Address - Country:US
Practice Address - Phone:256-445-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant