Provider Demographics
NPI:1649577404
Name:DAVIS, RENEE A (NP)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:MARRS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:737 E CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-5103
Mailing Address - Country:US
Mailing Address - Phone:785-827-7261
Mailing Address - Fax:
Practice Address - Street 1:737 E CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-5103
Practice Address - Country:US
Practice Address - Phone:782-827-7261
Practice Address - Fax:785-833-5707
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-98182-062163W00000X
KS53-75201-062363L00000X
KS53-75201363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200689470CMedicaid
KS200689470DMedicaid
KS200689470DMedicaid
KSP01105470Medicare PIN