Provider Demographics
NPI:1689214702
Name:DAVIS, MEGAN MAE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 SIMPSON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40008-6110
Mailing Address - Country:US
Mailing Address - Phone:859-492-5877
Mailing Address - Fax:
Practice Address - Street 1:202 S 4TH ST
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1008
Practice Address - Country:US
Practice Address - Phone:859-492-5877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily