Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LG0600X | Nurse Practitioner - Gerontology | 53-45638-111 | KS |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 45638 | KS |
NPI | 1033134143 |
---|---|
Provider Name | Ms. Tracy L Davies |
First Address | Topeka, KS 66606-2084 |
Second Address | Topeka, KS 66606-2084 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 24/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110661011 | MEDICARE PTAN (01) | KS |
200439000G | (05) | KS |
Q45697 | (02) | KS |