Provider Demographics
NPI:1659444594
Name:DAVIS-JACKSON, CHERIE JEANINE (RN MSN FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHERIE
Middle Name:JEANINE
Last Name:DAVIS-JACKSON
Suffix:
Gender:F
Credentials:RN MSN FNP
Other - Prefix:MRS
Other - First Name:CHERIE
Other - Middle Name:JEANINE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN MSN FNP
Mailing Address - Street 1:14745 GUADALUPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MURIETA
Mailing Address - State:CA
Mailing Address - Zip Code:95683-9438
Mailing Address - Country:US
Mailing Address - Phone:916-354-0743
Mailing Address - Fax:916-354-1732
Practice Address - Street 1:7001-A EAST PARKWAY
Practice Address - Street 2:PUBLIC HLTH SERVICES-ADMIN. STE. # 500
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2034
Practice Address - Country:US
Practice Address - Phone:916-875-5701
Practice Address - Fax:916-875-6366
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP73622Medicare UPIN