Provider Demographics
NPI:1295071553
Name:DAVIS, REGINA MARIE (CRNA, APN, MSN)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNA, APN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1668 NW 380TH RD
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64061-9010
Mailing Address - Country:US
Mailing Address - Phone:618-402-8244
Mailing Address - Fax:
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:SUITE # 100
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2303
Practice Address - Country:US
Practice Address - Phone:816-478-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003015763163W00000X
IL041367029163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1174504732OtherANESTHESIA ASSOCIATES OF KANSAS CITY NPI GROUP NUMBER