Provider Demographics
NPI:1295797512
Name:DAVIS, CONSTANCE A (MD)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:A
Other - Last Name:LUELLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 N CARRIAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4508
Mailing Address - Country:US
Mailing Address - Phone:316-858-5800
Mailing Address - Fax:316-858-5868
Practice Address - Street 1:800 N CARRIAGE PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4508
Practice Address - Country:US
Practice Address - Phone:316-858-5800
Practice Address - Fax:316-858-5868
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100422760AMedicaid
102201OtherBCBS
102201Medicare PIN
KS100422760AMedicaid