Provider Demographics
NPI:1942505706
Name:DAVIS, JORRI SHONTE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:JORRI
Middle Name:SHONTE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 COWAN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-4142
Mailing Address - Country:US
Mailing Address - Phone:601-502-3894
Mailing Address - Fax:
Practice Address - Street 1:540 COWAN STREET
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046
Practice Address - Country:US
Practice Address - Phone:516-210-5600
Practice Address - Fax:917-254-4419
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN739408163W00000X
WA61173059163W00000X, 363LF0000X
CARN95325319163W00000X
MSR870049363L00000X, 363LF0000X
PASP023870363LF0000X
KS53-79830-021363LF0000X
FL11015877363LF0000X
COC-RXN.0001402-C-NP363LF0000X
VA0024180866363LF0000X
OR202211989NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00303529Medicaid
MS30250I8854Medicare PIN
MS00303529Medicaid
MS319633YS8TMedicare PIN