Provider Demographics
NPI:1952723397
Name:DAVIS, JESSE CALE (CRNA)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:CALE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:CALE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:4455 S PADRE ISLAND DR STE 11
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5163
Mailing Address - Country:US
Mailing Address - Phone:361-883-6211
Mailing Address - Fax:361-882-4891
Practice Address - Street 1:6130 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2455
Practice Address - Country:US
Practice Address - Phone:361-883-6211
Practice Address - Fax:361-882-4891
Is Sole Proprietor?:No
Enumeration Date:2014-01-18
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR073518163W00000X
ARCTP-000260367500000X
TXAP125994367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse