Provider Demographics
NPI:1184346322
Name:DAVIS, JESSICA DIANE (NNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DIANE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 544
Mailing Address - Street 2:
Mailing Address - City:JOHNSON
Mailing Address - State:AR
Mailing Address - Zip Code:72741-0544
Mailing Address - Country:US
Mailing Address - Phone:479-684-3102
Mailing Address - Fax:
Practice Address - Street 1:4301 GREATHOUSE SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:JOHNSON
Practice Address - State:AR
Practice Address - Zip Code:72741
Practice Address - Country:US
Practice Address - Phone:479-684-3102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021005171163WN0002X
AR230625363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatalGroup - Single Specialty
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care