KELLY DAVIS (NPI# 1699388496) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699388496 |
| Entity Type | Individual |
| Full Name | KELLY DAVIS |
| Credential | FNP |
| Practice Address |
6326 Constitution Dr Fort Wayne IN 46804-1518 |
| Mailing Address |
4107 Rocky Knoll Ct Fort Wayne IN 46809-9534 |
| Practice Telephone | 2609696200 |
| Mailing Telephone | 2604668908 |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2020-08-31 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
71010315A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669081089 | Kelly Davis | Dental Hygienist | 741 Crystal Ln, Strasburg, VA 22657-2373 | 2020-07-31 |
| 1699270637 | Kelly Elise Davis | Student in an Organized Health Care Education/Training Program | 13001 E. 17th Pl., Campus Box F546, Bldg. 500, Room E2322, Aurora, CO 80045 | 2018-03-29 |
| 1659820074 | Kelly Kathleen Davis | Nurse Practitioner | 410 Lockerman St, Denton, MD 21629-1048 | 2016-09-27 |
| 1891243135 | Kelly Ann Davis | Nurse Anesthetist, Certified Registered | 19446 Parker St, Livonia, MI 48152-1579 | 2016-09-15 |
| 1881049120 | Kelly Ann Davis | Obstetrics & Gynecology | 7447 W Talcott Ave Ste 531, Chicago, IL 60631-3716 | 2016-04-24 |
| 1144611336 | Kelly Davis | Psychologist | 9525 S 93rd East Ave, Tulsa, OK 74133-6160 | 2015-02-10 |
| 1346501202 | Kelly Lynn Davis | Contractor | 18247 W Running Springs Rd, Park Hill, OK 74451-2017 | 2012-06-06 |
| 1518251826 | Kelly Megan Davis | Developmental Therapist | 10025 Hillview Dr Apt 28, Pensacola, FL 32514-5744 | 2011-06-03 |
| 1710271168 | Kelly Denise Davis | Developmental Therapist | 311 Heritage Dr, Mayfield, KY 42066-3432 | 2011-06-02 |
| 1386952307 | Kelly Davis | Speech-Language Pathologist | 2611 S Lees Summit Rd, Independence, MO 64055 | 2010-09-24 |
| Street Address |
6326 CONSTITUTION DR |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-1518 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922470970 | Jennifer Carol Littke | Nurse Practitioner | 6326 Constitution Dr, Fort Wayne, IN 46804-1518 | 2015-10-28 |
| 1285247403 | Christopher Heath Gambrel | Nurse Practitioner | 6326 Constitution Dr, Fort Wayne, IN 46804-1518 | 2020-08-27 |
| 1841808920 | Lisa Kay Krill | Nurse Practitioner | 6326 Constitution Dr, Fort Wayne, IN 46804-1518 | 2020-07-15 |
| 1720601651 | Wendy Jo Dabb | Nurse Practitioner | 6326 Constitution Dr, Fort Wayne, IN 46804-1518 | 2020-05-27 |
| 1619516465 | Leslie Ann Waldo | Nurse Practitioner | 6326 Constitution Dr, Fort Wayne, IN 46804-1518 | 2019-12-26 |
| 1316583479 | Araceli Correa | Nurse Practitioner | 6326 Constitution Dr, Fort Wayne, IN 46804-1518 | 2019-11-25 |
| 1154970879 | Casey Elizabeth Peterson | Nurse Practitioner | 6326 Constitution Dr, Fort Wayne, IN 46804-1518 | 2019-09-05 |
| 1265095897 | Ashley Kamea Lynn Brown | Nurse Practitioner | 6326 Constitution Dr, Fort Wayne, IN 46804-1518 | 2019-04-18 |
| 1639637341 | Michele Viers | Nurse Practitioner | 6326 Constitution Dr, Fort Wayne, IN 46804-1518 | 2019-03-12 |
| 1740754050 | Julie Fraze | Nurse Practitioner | 6326 Constitution Dr, Fort Wayne, IN 46804-1518 | 2019-01-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518566397 | Stacey Renee Pulver | Nurse Practitioner | 13134 Hollow Oak Rd, Fort Wayne, IN 46845-2327 | 2020-10-22 |
| 1649878554 | Heather Ormiston-leclear | Nurse Practitioner | 3800 N Anthony Blvd # Cc1335, Fort Wayne, IN 46805-1430 | 2020-10-13 |
| 1669081618 | Carly Ann Nahrwold | Nurse Practitioner | 7025 Old Trail Rd # 9574, Fort Wayne, IN 46809-2713 | 2020-07-27 |
| 1932725942 | Health Essential LLC | Nurse Practitioner | 3030 Lake Ave Ste 14, Fort Wayne, IN 46805-5428 | 2020-06-25 |
| 1942824842 | Carissa Miller | Nurse Practitioner | 707 Rollingwood Ln, Fort Wayne, IN 46845-1088 | 2020-06-05 |
| 1891329819 | Jasmine Monae Tubbs | Nurse Practitioner | 875 Petal Way, Fort Wayne, IN 46816-8900 | 2020-02-28 |
| 1235780362 | Elizabeth Rose Lichtsinn | Nurse Practitioner | 3919 W Jefferson Blvd Ste 200, Fort Wayne, IN 46804-6811 | 2019-09-20 |
| 1033676275 | Amanda Warner | Nurse Practitioner | 2229 Woods Rd, Fort Wayne, IN 46818-9539 | 2019-02-25 |
| 1669940714 | Brookelyn Agler | Nurse Practitioner | Summit Radiology, PC, 5001 Us Highway 30 W, Suite D, Fort Wayne, IN 46818-9701 | 2018-11-07 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
Please comment or provide details below to improve the information on KELLY DAVIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.