Provider Demographics
NPI:1255700142
Name:DAVIS, KATHERINE LYNN (MS, RN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, RN, AGACNP-BC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:273 FOUNDERS RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3213
Mailing Address - Country:US
Mailing Address - Phone:860-841-8100
Mailing Address - Fax:
Practice Address - Street 1:380 HENRY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6048
Practice Address - Country:US
Practice Address - Phone:860-841-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2267311363LA2100X
NYF430964-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care