Provider Demographics
NPI:1205800398
Name:DAVIS, KARRIE L (NP)
Entity type:Individual
Prefix:
First Name:KARRIE
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2300 E 3RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2700
Mailing Address - Country:US
Mailing Address - Phone:423-702-7900
Mailing Address - Fax:423-702-7905
Practice Address - Street 1:251 N LYERLY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2739
Practice Address - Country:US
Practice Address - Phone:423-826-8000
Practice Address - Fax:423-702-7915
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN07470363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3908015Medicaid
TN39080152Medicare PIN
TN3908015Medicaid