Provider Demographics
NPI:1003423559
Name:DAVIS, JENNIFER ANNETTE (RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNETTE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:NA
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:330 HARVEST MDW
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5060
Mailing Address - Country:US
Mailing Address - Phone:254-721-5204
Mailing Address - Fax:
Practice Address - Street 1:330 HARVEST MDW
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-5060
Practice Address - Country:US
Practice Address - Phone:254-721-5204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX903897163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health