De' Andra Destheenia Davis, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

49716 Issued in KY

Practice address

504 Hopkinsville St
Greenville, KY 42345-1104

Phone

(270) 338-6488

Fax

(270) 338-7868

NPI assigned

Dec 22, 2011

Sex

Female

Sole proprietor

No

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.

• Community Health Centers of Western Kentucky Inc

  • Federally Qualified Health Center (FQHC)
  • Greenville, KY
  • NPI 1649824426
  NPD (past) Pediatrics

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: ddavis76@yourcarecommunity.org

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 20, 2019.

{
    "created_epoch": "1324512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576800000000",
    "number": "1225307184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 HOPKINSVILLE ST",
            "city": "GREENVILLE",
            "state": "KY",
            "postal_code": "423451124",
            "telephone_number": "270-338-5777",
            "fax_number": "270-338-5765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 HOPKINSVILLE ST",
            "city": "GREENVILLE",
            "state": "KY",
            "postal_code": "423451104",
            "telephone_number": "270-338-6488",
            "fax_number": "270-338-7868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "DE' ANDRA",
        "middle_name": "DESTHEENIA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-22",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "MD.205560",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "49716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100444110",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cherriee Michellee Cornett, COTA
• Guinn Shaw Cost Jr., MD
• Minerva B Covarrubias, MD
• Katharine S Cox, MD
• Dagamac Enterprises LLC
• Kari Melissa Dechenne, M.D.
• Emily Diaz
• Diversicare of Greenville, LLC
• Allison Ducoff
• Lisa Kaa Dukes, MSN,ARNP

• All providers in Greenville, KY
• Pediatrics Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.