Provider Demographics
NPI:1932704236
Name:DAVIS, KATHLEEN M (CRNP-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2550 MOSSIDE BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3532
Mailing Address - Country:US
Mailing Address - Phone:412-457-1101
Mailing Address - Fax:412-457-0252
Practice Address - Street 1:2550 MOSSIDE BLVD STE 308
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3532
Practice Address - Country:US
Practice Address - Phone:412-457-1101
Practice Address - Fax:412-457-0252
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023235363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily