Provider Demographics
NPI:1194798405
Name:DAVIS, ROBERT LYLE (CRNA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LYLE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-2531
Mailing Address - Country:US
Mailing Address - Phone:620-342-8748
Mailing Address - Fax:620-342-0783
Practice Address - Street 1:1201 WEST 12TH AVENUE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2531
Practice Address - Country:US
Practice Address - Phone:620-343-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS55128367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered