Individual provider Active NPI

Kortni Michelle Davis, PA-C

  • Physician Assistant
  • Charleston, SC
National Provider Identifier
1639934193
Registry record updated Feb 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
96 Jonathan Lucas St
Charleston, SC 29425-8900
Phone
(843) 792-1414
NPI assigned
Feb 14, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

96 Jonathan Lucas St
Charleston, SC 29425-8900

Mailing address

6607 Buttercup Dr
Cheyenne, WY 82009-5718
Phone (307) 286-6894

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, SC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20241014002852 AL Practitioner - Physician Assistant 9234661398 Reassigns benefits to 1 organization
I20251209003332 SC Practitioner - Physician Assistant 9234661398 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1 Poston Rd
Charleston, SC 29407-3428

PO Box
Charlotte, NC 28275-1461

Hospital & facility affiliations

  • Musc Medical Center Hospital, Charleston, SC, CCN 420004

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
6138SCMDOrientation and Mobility Training Rehabilitation Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Associates of the Medical University of South Carol Physician Assistant CurrentSince Nov 1, 2025 Accepting new patients
University Medical Associates of the Medical University of South Carol CurrentSince Nov 1, 2025 Accepting new patients
University Medical Associates of the Medical University of South Carol Current Accepting new patients

Locations

171 Ashley Ave
Charleston, SC 29425
Phone (843) 792-2123

96 Jonathan Lucas St
Charleston, SC 29425
Phone (843) 792-3072

Organizations & group practices 4

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.

Hospital & facility affiliations 6

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": "1707868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771545600000",
    "number": "1639934193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6607 BUTTERCUP DR",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820095718",
            "telephone_number": "307-286-6894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 JONATHAN LUCAS ST",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294258900",
            "telephone_number": "843-792-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "KORTNI",
        "middle_name": "MICHELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-14",
        "last_updated": "2026-02-20",
        "certification_date": "2026-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.