Provider Demographics
NPI:1104975622
Name:DAVIS, KATHY DAI (CRNP)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:DAI
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:813 MAIDEN CHOICE LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3679
Mailing Address - Country:US
Mailing Address - Phone:410-402-2258
Mailing Address - Fax:410-204-7279
Practice Address - Street 1:785 ELKRIDGE LANDING RD STE 300
Practice Address - Street 2:
Practice Address - City:LINTHICUM HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:21090-2958
Practice Address - Country:US
Practice Address - Phone:443-323-3014
Practice Address - Fax:855-212-5249
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR144682363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD416893300OtherMEDICAL ASSISTANCE
MD94951602OtherCAREFIRST
DCE402 0022OtherCAREFIRST
MD152584ZDVXOtherMEDICARE
1221809OtherAMERIGROUP
GAP00726215OtherRAILROAD MEDICARE