John Davis Sr.

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

041341411 Issued in IL

Practice address

339 Kings Ridge Blvd
O Fallon, IL 62269-6327

Phone

(618) 624-2969

NPI assigned

Nov 6, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1383696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383696000000",
    "number": "1396174751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 KINGS RIDGE BLVD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622696327",
            "telephone_number": "618-624-2969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 KINGS RIDGE BLVD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622696327",
            "telephone_number": "618-624-2969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JOHN",
        "name_suffix": "Sr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-06",
        "last_updated": "2013-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2004009573",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041341411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica W Daniel, OTD, OTR/L
• Brandon Michael Daniels, DC
• David N. Pfohl, MD, LLC
• Tess David
• Alex Davie
• Leslie Davis, MA,LCPC
• Morgan Alice-Paige Delozier, DO
• Rachael Demattei, APRN
• Dentists of Ofallon PLLC
• Richard Derby, MD

• Registered Nurse in O Fallon, IL
• Providers in O Fallon, IL by specialty
• Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2013; 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.