Kristine Elizabeth Davis, FNP-BC, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71005614A Issued in IN

Practice address

2222 Rieth Blvd
Ste 100
Goshen, IN 46526-5869

Phone

(574) 875-1200

Fax

(574) 875-0362

NPI assigned

Jul 8, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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 Living Resources LLC

  • In Home Supportive Care Agency
  • Fort Wayne, IN
  • NPI 1780065425
  Medicare reassignment
• Visiting Nurse and Hospice Home Inc

  • Home Health Agency
  • Fort Wayne, IN
  • NPI 1083751002
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682640000000",
    "number": "1275916264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465301380",
            "telephone_number": "574-647-1840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 RIETH BLVD",
            "address_2": "STE 100",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465265869",
            "telephone_number": "574-875-1200",
            "fax_number": "574-875-0362"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1815 E Ireland Rd",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466142845",
            "country_code": "US",
            "telephone_number": "574-647-1750",
            "fax_number": "574-647-1748",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6913 N Main St",
            "address_purpose": "LOCATION",
            "city": "Granger",
            "state": "IN",
            "postal_code": "465308039",
            "country_code": "US",
            "telephone_number": "574-647-1500",
            "fax_number": "574-243-4306",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3301 County Road 6 E",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465147673",
            "country_code": "US",
            "telephone_number": "574-266-5342",
            "fax_number": "574-266-5847",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "KRISTINE",
        "middle_name": "ELIZABETH",
        "credential": "FNP-BC, FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-08",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71005614A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201313630",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kristine.davisnp.p1@direct.goshenphysicians.nextgenshare.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1824 Dorchester Ct",
            "city": "Goshen",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465266819",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Grace Catherine Darnell, MSN, NP-C, RN
• David Lehman DDS MSD Inc
• David Moore Counseling Services
• Daviess County Hospital
• Hailey Davis
• Aditi Dawar
• Orelia Daye, MSW
• Mariovani P De Freitas, PHARM.D
• Morgan Elizabeth De Kleine, CNM, FNP-BC
• Christiaan Erik De Vries, M.D.

• Family Nurse Practitioner in Goshen, IN
• Providers in Goshen, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.

Verify at the official NPI Registry.