Provider Demographics
NPI:1255437463
Name:DAVIS, YVONNE MADDELA (ARNP)
Entity type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:MADDELA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 KLUTEY PARK PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-3347
Mailing Address - Country:US
Mailing Address - Phone:270-830-6100
Mailing Address - Fax:270-826-3089
Practice Address - Street 1:471 KLUTEY PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3347
Practice Address - Country:US
Practice Address - Phone:270-830-6100
Practice Address - Fax:270-826-3089
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4417P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78013562Medicaid
KY1535502Medicare PIN
KYQ33112Medicare UPIN