Provider Demographics
NPI:1255889903
Name:DAVIS, JACOB KAMAN (DNP, APRN-CNP)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:KAMAN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DNP, APRN-CNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 N LOY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-1726
Mailing Address - Country:US
Mailing Address - Phone:903-957-0190
Mailing Address - Fax:
Practice Address - Street 1:2801 N LOY LAKE RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-1726
Practice Address - Country:US
Practice Address - Phone:903-957-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK102790363LF0000X
TXAP132457363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1255889903OtherSTATE LICENSE NURSE PRACTITIONER