Provider Demographics
NPI:1629243886
Name:DAVIS-JACKSON, JAMI VICTORIA (ACNP BC)
Entity Type:Individual
Prefix:MRS
First Name:JAMI
Middle Name:VICTORIA
Last Name:DAVIS-JACKSON
Suffix:
Gender:F
Credentials:ACNP BC
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Mailing Address - Street 1:12101 WOODCREST EXECUTIVE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5047
Mailing Address - Country:US
Mailing Address - Phone:314-317-0600
Mailing Address - Fax:314-317-0606
Practice Address - Street 1:1 SAINT ANTHONYS WAY
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4568
Practice Address - Country:US
Practice Address - Phone:314-317-0600
Practice Address - Fax:314-317-0606
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2014-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL209-007873363LA2100X
MO2001031602363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1629243886Medicaid
MO1629243886Medicaid
IL1629243886Medicaid
MO1629243886Medicaid