Active NPI
Kristina Starr Davis, LCSW
- Clinical Social Worker
- Appleton, WI
National Provider Identifier
1902019763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 2709-123
- Practice address
- 300 N Woods Edge Dr
Appleton, WI 54914-3149 - Phone
- (920) 738-7795
- Fax
- (920) 882-5448
- NPI assigned
- May 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 2709-123 | WI | Primary |
Addresses
Primary practice location
300 N Woods Edge Dr
Appleton, WI 54914-3149
Mailing address
300 N Woods Edge Dr
Appleton, WI 54914-3149
Phone (920) 738-7795
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2709-123 | WI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178582400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902019763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 N WOODS EDGE DR",
"city": "APPLETON",
"state": "WI",
"postal_code": "549143149",
"telephone_number": "920-738-7795",
"fax_number": "920-882-5448"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 N WOODS EDGE DR",
"city": "APPLETON",
"state": "WI",
"postal_code": "549143149",
"telephone_number": "920-738-7795",
"fax_number": "920-882-5448"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "KRISTINA",
"middle_name": "STARR",
"name_prefix": "Miss",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "2709-123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.