Individual
MRS. KIM GENELLE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
118 W. 4TH, LEBO, KS 66856
(620) 256-6346
(620) 256-6219
Mailing address
1500 SW 10TH AVE, MEDICAL STAFF SERVICES, TOPEKA, KS 66604
(785) 354-6241
(785) 270-4343
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
45161
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068002265
MEDICARE PTAN
KS
05
—
100428830D
—
KS
05
—
100428830E
—
KS
01
—
161507
BCBS
KS
Enumeration date
03/24/2006
Last updated
12/19/2019
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