NPIMap

Individual provider Active NPI

Keith Davidson, NP-C

  • Adult Health Nurse Practitioner
  • Deckerville, MI
National Provider Identifier
1366827982
Registry record updated Aug 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
4704275292 Issued in MI
Practice address
2433 Black River St
Deckerville, MI 48427-9425
Phone
(810) 376-2885
NPI assigned
Jul 24, 2015
Last updated
Aug 25, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 4704275292 MI Primary

Addresses

Primary practice location

2433 Black River St
Deckerville, MI 48427-9425

Mailing address

PO Box 126
3532 Main Street
Deckerville, MI 48427-0126
Phone (810) 376-3100

Other practice location 1

416 Woodland Dr
Sandusky, MI 48471-1047
Phone (810) 202-6022

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150813011934 MI Practitioner - Nurse Practitioner 0547575953 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3559 Pine St
Deckerville, MI 48427-7703
Phone (810) 376-2885

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704274292MIMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Deckerville Community Hospital, Inc CurrentSince Aug 5, 2015 Accepting new patients
Deckerville Community Hospital, Inc. CurrentSince Aug 5, 2015 Accepting new patients
Hills & Dales General Hospital, Inc. CurrentSince Jan 1, 2025 Accepting new patients
Hills & Dales General Hospital, Inc. CurrentSince Jan 1, 2025 Accepting new patients

Locations

4675 Hill St
Cass City, MI 48726
Phone (989) 872-2121

2030 Black River St
Deckerville, MI 48427
Phone (810) 376-2835

2433 Black River St
Deckerville, MI 48427
Phone (810) 376-2835

3559 Pine St
Deckerville, MI 48427
Phone (810) 376-2835

2750 Main St
Ste 6
Marlette, MI 48453
Phone (810) 376-2885

Interoperability endpoints

  • Direct secure messaging: kdavidson179146@direct.covenanthealthcare.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1437696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787616000000",
    "number": "1366827982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 126",
            "address_2": "3532 MAIN STREET",
            "city": "DECKERVILLE",
            "state": "MI",
            "postal_code": "484270126",
            "telephone_number": "810-376-3100",
            "fax_number": "810-376-8311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2433 BLACK RIVER ST",
            "city": "DECKERVILLE",
            "state": "MI",
            "postal_code": "484279425",
            "telephone_number": "810-376-2885"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "416 Woodland Dr",
            "address_purpose": "LOCATION",
            "city": "Sandusky",
            "state": "MI",
            "postal_code": "484711047",
            "country_code": "US",
            "telephone_number": "810-202-6022",
            "fax_number": "248-460-5752",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "KEITH",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-24",
        "last_updated": "2026-08-25",
        "certification_date": "2026-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": "4704275292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deckerville, MI

Sources for this page

Verify at the official NPI Registry.