Provider Demographics
NPI:1154805877
Name:DAVIS, KATHLEEN L (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 9218
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-9218
Mailing Address - Country:US
Mailing Address - Phone:561-263-7010
Mailing Address - Fax:
Practice Address - Street 1:5430 MILITARY TRAIL
Practice Address - Street 2:STE 64
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2873
Practice Address - Country:US
Practice Address - Phone:561-263-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3275952363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care