Individual provider Active NPI

Christy Lynn Davis, APRN-CNP

  • Neonatal Nurse Practitioner
  • Tulsa, OK
National Provider Identifier
1821499336
Registry record updated Apr 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal Nurse PractitionerTaxonomy code 363LN0000X
License
R0112502 Issued in OK
Practice address
1120 S Utica Ave Ste 2123
Tulsa, OK 74104-4012
Phone
(918) 579-5402
Fax
(918) 579-5404
NPI assigned
Sep 16, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal Nurse Practitioner 363LN0000X 2018009258 MO
Neonatal Nurse Practitioner 363LN0000X R66633 AR
Neonatal Nurse Practitioner 363LN0000X R0112502 OK Primary

Addresses

Primary practice location

1120 S Utica Ave Ste 2123
Tulsa, OK 74104-4012

Mailing address

1120 S Utica Ave Ste 2123
Tulsa, OK 74104-4012
Phone (918) 579-5402

Other practice location 1

100 Mercy Way
Joplin, MO 64804-4524
Phone (417) 556-6428

Other names 1

  • Christy Lynn Sullivan Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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 1

Enrollment IDStateProvider typePAC IDDetails
I20180416001977 MO Practitioner - Nurse Practitioner 6608139100 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R66633ARMDNeonatal Nurse Practitioner
R0112502OKMDNeonatal Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Joplin LLC CurrentSince Apr 9, 2018 Accepting new patients

Locations

1717 S Range Line Rd
Ste B
Joplin, MO 64804
Phone (417) 556-2231

100 Mercy Way
Joplin, MO 64804
Phone (417) 556-2300

9735 Landmark Parkway Dr
Saint Louis, MO 63127
Phone (314) 842-6223

1120 S Utica Ave
Ste 2123
Tulsa, OK 74104
Phone (918) 579-5402

Interoperability endpoints

  • Direct secure messaging: christy.davis@direct.stjohnhealthsystem.com

Organizations & group practices 1

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": "1410825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522886400000",
    "number": "1821499336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 S UTICA AVE STE 2123",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044012",
            "telephone_number": "918-579-5402",
            "fax_number": "918-579-5404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 S UTICA AVE STE 2123",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044012",
            "telephone_number": "918-579-5402",
            "fax_number": "918-579-5404"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Mercy Way",
            "address_purpose": "LOCATION",
            "city": "Joplin",
            "state": "MO",
            "postal_code": "648044524",
            "country_code": "US",
            "telephone_number": "417-556-6428",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "CHRISTY",
        "middle_name": "LYNN",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-16",
        "last_updated": "2018-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "MO",
            "license": "2018009258",
            "primary": false
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "AR",
            "license": "R66633",
            "primary": false
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "OK",
            "license": "R0112502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTY",
            "last_name": "SULLIVAN",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.