Provider Demographics
NPI:1902412117
Name:LITTLE, DAVINA I (APRN)
Entity Type:Individual
Prefix:MRS
First Name:DAVINA
Middle Name:I
Last Name:LITTLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-2361
Mailing Address - Country:US
Mailing Address - Phone:316-775-7500
Mailing Address - Fax:
Practice Address - Street 1:2820 OHIO ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KS
Practice Address - Zip Code:67010-2361
Practice Address - Country:US
Practice Address - Phone:316-775-7500
Practice Address - Fax:316-775-3685
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79586363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS27-0040297OtherTAX ID
KS201308970AMedicaid