Provider Demographics
NPI:1003008475
Name:DAVIS, JENNIFER KAY (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1377
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31534-1377
Mailing Address - Country:US
Mailing Address - Phone:912-389-1477
Mailing Address - Fax:
Practice Address - Street 1:901 CONNECTOR 206 N
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-7150
Practice Address - Country:US
Practice Address - Phone:912-389-6885
Practice Address - Fax:912-393-1015
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN057110 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily