Individual
DENESE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3500 S LAFOUNTAIN ST, KOKOMO, IN 46902-3803
(765) 776-3500
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-7584
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71011408A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
266180J55
INDIV MEDICARE PTAN
IN
05
—
300054050
—
IN
01
—
Q00265548
RAILROAD MEDICARE
IN
Enumeration date
08/09/2021
Last updated
05/24/2022
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