NPIMap

Individual provider Active NPI

Kristin Russell Davis, FNP-BC

  • Family Nurse Practitioner
  • Camden, TN
National Provider Identifier
1508182726
Registry record updated Feb 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
14933 Issued in TN
Practice address
306 Highway 641 N
Camden, TN 38320-3012
Phone
(731) 213-2344
Fax
(731) 352-4459
NPI assigned
Apr 13, 2010
Last updated
Feb 13, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 14933 TN Primary

Addresses

Primary practice location

306 Highway 641 N
Camden, TN 38320-3012

Mailing address

205 Hospital Dr
Suite a
MC Kenzie, TN 38201-1649
Phone (731) 352-7907

Other practice location 1

205 Hospital Dr
Suite a
Mc Kenzie, TN 38201-1649
Phone (731) 352-7907 ext. 429

Other identifiers 2

IdentifierTypeStateIssuer
3380640OtherTNGROUP MEDICARE
3380640OtherTNGROUP MEDICAID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20210629001362 TN Practitioner - Nurse Practitioner 4486824406 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McKenzie Medical Center PCGroup PAC ID 2365427853, 32 clinicians

Practice addresses (Care Compare)

205 A Hospital Dr
MC Kenzie, TN 38201-2024
Phone (901) 352-7907

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Medical Clinic PLLC CurrentSince Aug 22, 2015 Accepting new patients
Fast Pace Medical Clinic PLLC CurrentSince Aug 22, 2015 Accepting new patients
McKenzie Medical Center PC Family CurrentSince Aug 22, 2015 Accepting new patients
McKenzie Medical Center PC Current Accepting new patients
McKenzie Medical Center PC CurrentSince Aug 22, 2015 Accepting new patients
McKenzie Clinic Corp Past Accepting new patients
McKenzie Medical Center, PC Family Past Accepting new patients
McKenzie Medical Center Past Accepting new patients
McKenzie Medical Center PC Family Past Accepting new patients
McKenzie Medical Center Family Past Accepting new patients

Locations

30810 Broad St
Bruceton, TN 38317
Phone (731) 586-4800

306 Highway 641 N
Camden, TN 38320
Phone (731) 213-2344

811 Morrow St
Ste 207
Dresden, TN 38225
Phone (731) 364-4900

105 N Cedar St
Gleason, TN 38229
Phone (731) 648-5634

1894 Cedar St
Mc Kenzie, TN 38201
Phone (731) 207-6496

205 Hospital Dr
Ste A
Mc Kenzie, TN 38201
Phone 7313527907 ext. 429

205C Hospital Dr
Mc Kenzie, TN 38201
Phone (731) 352-0820

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1568/brand/1/csg/21/fhir/r4
  • Direct secure messaging: kdavis536130@direct.bmhcc.org

Organizations & group practices 10

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 7

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": "1271116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1508182726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 HOSPITAL DR",
            "address_2": "SUITE A",
            "city": "MC KENZIE",
            "state": "TN",
            "postal_code": "382011649",
            "telephone_number": "731-352-7907",
            "fax_number": "731-352-4459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 HIGHWAY 641 N",
            "city": "CAMDEN",
            "state": "TN",
            "postal_code": "383203012",
            "telephone_number": "731-213-2344",
            "fax_number": "731-352-4459"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 Hospital Dr",
            "address_2": "SUITE A",
            "address_purpose": "LOCATION",
            "city": "Mc Kenzie",
            "state": "TN",
            "postal_code": "382011649",
            "country_code": "US",
            "telephone_number": "731-352-7907 x429",
            "fax_number": "731-352-4459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "KRISTIN",
        "middle_name": "RUSSELL",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-13",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "14933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE",
            "identifier": "3380640",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICAID",
            "identifier": "3380640",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Camden, TN

Sources for this page

Verify at the official NPI Registry.