Provider Demographics
NPI:1740767375
Name:DAVIS, JILL RENEE (APRN)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:RENEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S CHURCH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4112
Mailing Address - Country:US
Mailing Address - Phone:870-935-6012
Mailing Address - Fax:870-934-3156
Practice Address - Street 1:800 S CHURCH ST STE 400
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4112
Practice Address - Country:US
Practice Address - Phone:870-935-6012
Practice Address - Fax:870-934-3156
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005796363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics