Provider Demographics
NPI:1447572136
Name:DAVIS, JENNIFER ELIZABETH (FNPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 CLEVELAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-6700
Mailing Address - Country:US
Mailing Address - Phone:307-426-4916
Mailing Address - Fax:877-585-7008
Practice Address - Street 1:1202 CLEVELAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-6700
Practice Address - Country:US
Practice Address - Phone:307-426-4916
Practice Address - Fax:877-585-7008
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY20951.1029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily