Provider Demographics
NPI:1639402738
Name:DAVIS, JEFFERY SCOTT (APN RN)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:SCOTT
Last Name:DAVIS
Suffix:
Gender:
Credentials:APN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 LEMAY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-2408
Mailing Address - Country:US
Mailing Address - Phone:314-262-4875
Mailing Address - Fax:
Practice Address - Street 1:777 CRAIG RD STE 200
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7190
Practice Address - Country:US
Practice Address - Phone:314-776-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV867801363LF0000X, 363LP0808X
MO147666363LF0000X, 363LP0808X
IL277002897363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209007722Medicaid