Provider Demographics
NPI:1376791723
Name:DAVIS-JACKSON, WALINDA (APRN, CNP, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:WALINDA
Middle Name:
Last Name:DAVIS-JACKSON
Suffix:
Gender:F
Credentials:APRN, CNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5652 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2402
Mailing Address - Country:US
Mailing Address - Phone:440-439-5818
Mailing Address - Fax:
Practice Address - Street 1:5652 MEADOW LN
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-2402
Practice Address - Country:US
Practice Address - Phone:440-439-5818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 245899163W00000X
OH024186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse