Kent Charles Davis, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

31759 Issued in MN

Practice address

411 3Rd St N
Waite Park, MN 56387-1177

Phone

(320) 253-4120

Fax

(320) 253-4179

NPI assigned

Jun 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Central Minnesota Mental Health Center

  • Mental Health Counselor
  • Saint Cloud, MN
  • NPI 1831177195
  Medicare reassignment NPD
• Central Minnesota Mental Health Center

  • Counselor
  • Saint Cloud, MN
  • NPI 1053576546
  NPD
• Central Minnesota Mental Health Center

  • Mental Health Counselor
  • Elk River, MN
  • NPI 1164934303
  NPD (past)

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704758400000",
    "number": "1568406387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 3RD ST N STE 4",
            "city": "WAITE PARK",
            "state": "MN",
            "postal_code": "563870003",
            "telephone_number": "320-253-4120",
            "fax_number": "320-253-4179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 3RD ST N",
            "city": "WAITE PARK",
            "state": "MN",
            "postal_code": "563871177",
            "telephone_number": "320-253-4120",
            "fax_number": "320-253-4179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "KENT",
        "middle_name": "CHARLES",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "31759",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP25413",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8L641DA",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "110587C851",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "1520376",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "561597600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "92224583001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Danda, M.S., C.P.R.P.
• Erin Danielson
• Katelynn Marie Danielson
• Cecelia Davis
• Jon Michael Davis, D.C.
• Stephanie Anne De Leon
• Lynn Dent
• Paige Deters, PA-C
• Angela Catherine Devore
• Ali Hassan Dhahir

• Psychiatry Physician in Waite Park, MN
• Providers in Waite Park, MN by specialty
• Psychiatry Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.