Provider Demographics
NPI:1942523030
Name:DAVIS, KATHRYN M (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:510 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3554
Mailing Address - Country:US
Mailing Address - Phone:812-282-1888
Mailing Address - Fax:812-218-9318
Practice Address - Street 1:510 SPRING ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3554
Practice Address - Country:US
Practice Address - Phone:812-282-1888
Practice Address - Fax:812-218-9318
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2015-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006500363LP0808X
IN71003200A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50029506OtherPASSPORT
1487872636OtherRAILROAD GROUP NUMBER ARNP
KY82900176OtherMEDICAID THERAPY GROUP
KY2444451000OtherPASSPORT GROUP
KY78903689OtherMEDICAID ARNP GROUP
KYP00830158OtherRAILROAD MEDICARE #
000000653631OtherANTHEM
KY6764OtherMEDICARE GROUP
IN100386460OtherMEDICAID GROUP
IN160780OtherMEDICARE GROUP
IN160860OtherMEDICARE GROUP
IN200977990Medicaid
KY7100113360Medicaid
INCG2274OtherMEDICARE RAILROAD GROUP
INP00830157OtherRAILROAD MEDICARE #
000000056294OtherANTHEM GROUP #
50704000OtherMAGELLAN GROUP MIS
KY65927857OtherMEDICAID GROUP
50704000OtherMAGELLAN GROUP MIS
KY78903689OtherMEDICAID ARNP GROUP