Active NPI
Katilyn Marie Davis, CNP
- Gerontology Nurse Practitioner
- Crystal, MN
National Provider Identifier
1043395361
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- R188521-1
- Practice address
- 5200 Douglas Dr N
Crystal, MN 55429-3104 - Phone
- (888) 290-1209
- NPI assigned
- Oct 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | R188521-1 | MN | Primary |
Addresses
Primary practice location
5200 Douglas Dr N
Crystal, MN 55429-3104
Mailing address
5200 Douglas Dr N
Crystal, MN 55429-3104
Phone (888) 290-1209
Other practice location 1
10617 Kyle Ave N
Brooklyn Park, MN 55443-1249
Phone (612) 802-4972
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | katilyn.davis.1@31254.direct.athenahealth.com | Direct | Herself Health MN PC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
5200 Douglas Dr N
Crystal, MN 55429-3104
Phone (763) 400-3628
5520 Ridgewood CV
Minnetrista, MN 55364-8239
Phone 80087305611
Hospital & facility affiliations
- Accentcare Fairview Home Health - West, LLC
- Park Nicollet Methodist Hospital
- Park Nicollet Methodist Hospital
- Abbott Northwestern Hospital
- North Memorial Health Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R188521-1 | MN | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Herself Health MN PC | Current | Accepting new patients | |
| Consultative Health and Medicine, PA | Current | Accepting new patients |
Locations
5200 Douglas Dr N
Minneapolis, MN 55429
Phone (763) 400-3628
2004 Ford Pkwy
Saint Paul, MN 55116
Phone (612) 256-8225
Interoperability endpoints
- katilyn.davis.1@31254.direct.athenahealth.com
- https://api.platform.athenahealth.com/31254/brand/1/csg/1/fhir/r4
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Minnetrista, MN
- NPI 1710281647
-
- Internal Medicine Physician
- Saint Paul, MN
- NPI 1326775420
Hospital & facility affiliations 35
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Saint Paul, MN
- NPI 1477169233
-
- Obesity Medicine (Family Medicine) Physician
- Minneapolis, MN
- NPI 1154684835
Hospital
-
- Physical Medicine & Rehabilitation Physician
- Minneapolis, MN
- NPI 1275577215
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1767916800000",
"number": "1043395361",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5200 DOUGLAS DR N",
"city": "CRYSTAL",
"state": "MN",
"postal_code": "554293104",
"telephone_number": "888-290-1209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5200 DOUGLAS DR N",
"city": "CRYSTAL",
"state": "MN",
"postal_code": "554293104",
"telephone_number": "888-290-1209"
}
],
"practiceLocations": [
{
"address_1": "10617 Kyle Ave N",
"address_purpose": "LOCATION",
"city": "Brooklyn Park",
"state": "MN",
"postal_code": "554431249",
"country_code": "US",
"telephone_number": "612-802-4972",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DAVIS",
"first_name": "KATILYN",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-26",
"last_updated": "2026-01-09",
"certification_date": "2026-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "MN",
"license": "R188521-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "katilyn.davis.1@31254.direct.athenahealth.com",
"affiliation": "Y",
"affiliationName": "Herself Health MN PC",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "5200 Douglas Dr N",
"city": "Crystal",
"state": "MN",
"country_code": "US",
"postal_code": "554293104",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Crystal, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.