Active NPI
Katy Davis
- General Practice Physician
- Jacksonville, FL
National Provider Identifier
1124775754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 0101279685
- Practice address
- 2080 Child St
Jacksonville, FL 32214-2575 - Phone
- (904) 542-9417
- NPI assigned
- Mar 3, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 0101279685 | VA | Primary |
Addresses
Primary practice location
2080 Child St
Jacksonville, FL 32214-2575
Mailing address
100 Brewster Blvd
Camp Lejeune, NC 28547-2575
Phone (910) 449-2649
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231120000094 | VA | Order and Referring Only - Family Practice | 9739537473 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695340800000",
"number": "1124775754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 BREWSTER BLVD",
"city": "CAMP LEJEUNE",
"state": "NC",
"postal_code": "285472575",
"telephone_number": "910-449-2649"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2080 CHILD ST",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322142575",
"telephone_number": "904-542-9417"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "KATY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-03-03",
"last_updated": "2023-09-22",
"certification_date": "2023-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "VA",
"license": "0101279685",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.