# DAVIKA JON KUPER MATTOX

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1013045137
- **Gender:** F
- **Credential:** APRN

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | 1108490 | KY | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 3008791 | KY | Yes |

## Other

- **Enumeration date:** 03/01/2007
- **Last updated:** 01/11/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000560517 | ANTHEM BCBS | — |
| 05 | — | 30610026 | — | KY |
| 05 | — | 7100317090 | — | KY |