Provider Demographics
NPI:1184651556
Name:DAVIS, JENNIFER (CNM)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:DAVIS-JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNM
Mailing Address - Street 1:260 MONROE AVE
Mailing Address - Street 2:ATT: JENNIFER DAVIS
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-1518
Mailing Address - Country:US
Mailing Address - Phone:304-398-4949
Mailing Address - Fax:304-398-4952
Practice Address - Street 1:260 MONROE AVE
Practice Address - Street 2:ATT: JENNIFER DAVIS
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-1518
Practice Address - Country:US
Practice Address - Phone:304-398-4949
Practice Address - Fax:304-398-4952
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV44218163W00000X
WV119163WW0101X, 163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No163W00000XNursing Service ProvidersRegistered Nurse
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient