Kim Davis, NP

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

904961 Issued in MS

Practice address

112 W Peeler Ave
Shaw, MS 38773-8710

Phone

(662) 754-3301

NPI assigned

Dec 1, 2021

Last updated

Dec 1, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1638316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1861150401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 W PEELER AVE",
            "city": "SHAW",
            "state": "MS",
            "postal_code": "387738710",
            "telephone_number": "662-754-3301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 W PEELER AVE",
            "city": "SHAW",
            "state": "MS",
            "postal_code": "387738710",
            "telephone_number": "662-754-3301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "KIM",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-01",
        "last_updated": "2021-12-01",
        "certification_date": "2021-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "904961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Boa Vida Hospital of Aberdeen, Ms LLC (MRH Medical Group, Shaw Family Medical Clinic)
• Willie Mary Bolden
• Shekendra Patty Bryant
• Bradley Alan Cooper, OT
• Victoria Curry
• Naala Latrice Davis, FNP
• Delta Drugs Inc
• Kimberly Drake
• Dream Lab Drug and Alcohol Testing (Dream Lab Drug and Alcohol Testing (1))
• Regina Jonelle Evans, FNP

• Family Medicine Physician in Shaw, MS
• Providers in Shaw, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.