Provider Demographics
NPI:1346758430
Name:DAVIS, JESSICA NICOLE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 22ND AVE N # C
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1873
Mailing Address - Country:US
Mailing Address - Phone:615-321-1808
Mailing Address - Fax:615-321-1815
Practice Address - Street 1:309 22ND AVE N # C
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1873
Practice Address - Country:US
Practice Address - Phone:615-321-1808
Practice Address - Fax:615-321-1815
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist