Provider Demographics
NPI:1760206734
Name:DAVIS, KANNIKA MARIE (FNP)
Entity type:Individual
Prefix:
First Name:KANNIKA
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 COVINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-8090
Mailing Address - Country:US
Mailing Address - Phone:901-252-6066
Mailing Address - Fax:901-384-0260
Practice Address - Street 1:2860 COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-8090
Practice Address - Country:US
Practice Address - Phone:901-252-6066
Practice Address - Fax:901-384-0260
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN00000349492080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine