Provider Demographics
NPI:1275863870
Name:DAVIS, KAREN LOUISE (MSN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LOUISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LOUISE
Other - Last Name:MOYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1520 LILIHA ST STE 601
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3564
Mailing Address - Country:US
Mailing Address - Phone:808-523-0445
Mailing Address - Fax:808-356-3380
Practice Address - Street 1:275 PONAHAWAI ST STE 202
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3074
Practice Address - Country:US
Practice Address - Phone:808-523-0445
Practice Address - Fax:808-356-3380
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-4417-0363L00000X
HIRN-116716-0363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI12093067OtherCAQH
DE1275863870Medicaid
HI12093067OtherCAQH
MD512113200Medicaid