Provider Demographics
NPI:1275712986
Name:DAVIS, JENNIFER LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TRU COMMUNITY CARE
Mailing Address - Street 2:2425 TRAILRIDGE DR EAST
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026
Mailing Address - Country:US
Mailing Address - Phone:303-449-7740
Mailing Address - Fax:303-604-5393
Practice Address - Street 1:TRU COMMUNITY CARE
Practice Address - Street 2:2425 TRAILRIDGE DR EAST
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026
Practice Address - Country:US
Practice Address - Phone:303-449-7740
Practice Address - Fax:303-604-5393
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01817207R00000X
NC200801817207RH0002X
CODR.0067082207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC341553Medicare PIN
NC2073925AMedicare PIN