Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kisha R Davis

Individual provider Adult Health Nurse Practitioner · NPI 1770431058

Kisha R Davis is a Nurse Practitioner in Fairview Heights, Illinois. Qualified in 2025, 1 year ago. Practices as a sole proprietor. Licensed in Missouri.

Years since qualifying
1
Licensed in
MO
In the registry since
2026

Practice location Address checks out

864 Harbor Woods Dr
Fairview Heights, IL 62208-2189
Phone: (314) 448-5033
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adult Health Nurse Practitioner (primary) Taxonomy 363LA2200X · Licence 2026014984 (MO)

Record details

NPI number1770431058
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedMarch 20, 2026
Last updated in NPPESApril 6, 2026
Certification dateApril 6, 2026
Mailing address864 Harbor Woods Dr, Fairview Heights, IL 62208-2189

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Fairview Heights