Individual provider Active NPI

Kathleen Carol Davis, FNP

  • Family Nurse Practitioner
  • Des Moines, IA
National Provider Identifier
1548750045
Registry record updated Oct 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A152354 Issued in IA
Practice address
1200 University Ave Ste 120
Des Moines, IA 50314-2355
Phone
(515) 248-1500
Fax
(515) 248-1510
NPI assigned
May 10, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209017602 IL
Family Nurse Practitioner 363LF0000X A152354 IA Primary

Addresses

Primary practice location

1200 University Ave Ste 120
Des Moines, IA 50314-2355

Mailing address

1200 University Ave Ste 200
Des Moines, IA 50314-2355
Phone (515) 248-1447

Other practice location 1

1555 N Sandburg Ter Apt 412
Chicago, IL 60610-1335
Phone (773) 738-8942

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209017602ILMDNurse Practitioner
A152354IAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Health Care, Inc. CurrentSince Oct 1, 2018 Accepting new patients
Primary Health Care, Inc. CurrentSince Oct 1, 2018 Accepting new patients

Locations

3509 E 29th St
Des Moines, IA 50317
Phone (515) 248-1600

1200 University Ave
Ste 200
Des Moines, IA 50314
Phone (515) 248-1447

1200 University Ave
Ste 120
Des Moines, IA 50314
Phone (515) 248-1500

2353 SE 14th St
Des Moines, IA 50320
Phone (515) 248-1400

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CBABCD/Endpoint/CBABCD

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539302400000",
    "number": "1548750045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 UNIVERSITY AVE STE 200",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503142355",
            "telephone_number": "515-248-1447",
            "fax_number": "515-248-1440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 UNIVERSITY AVE STE 120",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503142355",
            "telephone_number": "515-248-1500",
            "fax_number": "515-248-1510"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1555 N Sandburg Ter Apt 412",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606101335",
            "country_code": "US",
            "telephone_number": "773-738-8942",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "KATHLEEN",
        "middle_name": "CAROL",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-10",
        "last_updated": "2018-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209017602",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IA",
            "license": "A152354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Moines, IA

Sources for this page

Verify at the official NPI Registry.