Provider Demographics
NPI:1295061463
Name:DAVIS, SHONTA DENISE
Entity type:Individual
Prefix:
First Name:SHONTA
Middle Name:DENISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHONTA
Other - Middle Name:DENISE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14460 W 121ST TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-6056
Mailing Address - Country:US
Mailing Address - Phone:913-390-8211
Mailing Address - Fax:
Practice Address - Street 1:14460 W 121ST TER
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-6056
Practice Address - Country:US
Practice Address - Phone:913-390-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13102694122163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse