ARIANNE DAVIS (AGNP-C) – Primary Care Nurse Practitioner, NPI 1104622547

ARIANNE DAVIS (AGNP-C) is a healthcare provider. based in Minnetonka, Minnesota. specializing in NURSE PRACTITIONER. They hold the professional credentials AGNP-C. They hold a License No. 12631 (MN). The NPI Number for ARIANNE DAVIS (AGNP-C) is 1104622547

Main info

Female
Sole Proprietor
2 Years Of Experience
Accepts Medicare Assignment
Name
ARIANNE DAVIS (AGNP-C)
NPI
1104622547
Phone
(213) 389-1863
Address
4200 WINCHESTER CT
Enumeration Date
24 February 2025
Last Update Date
26 March 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7372266700
Graduation Year
2024 (2 years ago)
PAC ID
3577080050
Group Practice PAC ID
6305233461
Professional Enrollment ID
I20250508000401
Address ID
MN554372040MI5123XSTXX401
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness75
Years active:1State licenses:1Digital endpointsOther names

5,720 NURSE PRACTITIONER in MN

Provider Addresses for ARIANNE DAVIS (AGNP-C)

  • 4200 WINCHESTER CT

    MINNETONKA, MN 553452555

    Phone: (213) 389-1863

    Type: Mailing

  • 5430 BOONE AVE N

    NEW HOPE, MN 55428

    Phone: (763) 592-2600

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-05-08

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250508000401INurse PractitionerMNTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55345)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6305233461View full group profile
NameSpecialtyState
Nurse PractitionerMN
Hospitalist, Internal MedicineIA
Emergency MedicineMN
Nurse PractitionerWI
Nurse PractitionerTX
Physician AssistantTX
Nurse PractitionerMN
Physician AssistantMN
Nurse PractitionerMN
Nurse PractitionerSD

Reviews

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Frequently asked questions

How do I look up ARIANNE DAVIS (AGNP-C) by NPI?
Use NPI 1104622547 when you need to reference ARIANNE DAVIS (AGNP-C) in forms, claims, or directories.
Is ARIANNE DAVIS (AGNP-C)'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
Does ARIANNE DAVIS (AGNP-C) list a primary specialty?
If you are matching referrals, note Primary Care Nurse Practitioner for ARIANNE DAVIS (AGNP-C). Clinical services aligned with this taxonomy classification.
Where is ARIANNE DAVIS (AGNP-C)'s primary listing?
We display Minnetonka, Minnesota because that is what the record indicates for ARIANNE DAVIS (AGNP-C).
Is ARIANNE DAVIS (AGNP-C) a real provider?
This page reflects official NPPES data for NPI 1104622547. Always confirm identity and privileges with the practice and licensing boards.

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