Active NPI
R Glenn Davis, CRNA
- Certified Registered Nurse Anesthetist
- Kingsport, TN
National Provider Identifier
1548210800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- RN35683
- Practice address
- 2000 Brookside Dr
Kingsport, TN 37660-4627 - Phone
- (423) 857-7000
- NPI assigned
- May 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | RN35683 | TN | Primary |
Addresses
Primary practice location
2000 Brookside Dr
Kingsport, TN 37660-4627
Mailing address
238 Lake Meadow Dr
Johnson City, TN 37615-4015
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3602775 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN35683 | TN | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1548210800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "238 LAKE MEADOW DR",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376154015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 BROOKSIDE DR",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376604627",
"telephone_number": "423-857-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "R",
"middle_name": "GLENN",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-10",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "TN",
"license": "RN35683",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3602775",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kingsport, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.