Provider Demographics
NPI:1891182267
Name:DAVIS, GRETCHEN (FNP-C)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials: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:PO BOX 875743
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64187-5743
Mailing Address - Country:US
Mailing Address - Phone:913-215-5008
Mailing Address - Fax:816-447-3960
Practice Address - Street 1:3066 SW GRANDSTAND CIR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-3866
Practice Address - Country:US
Practice Address - Phone:913-215-5008
Practice Address - Fax:816-447-3960
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015011913363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily