Healthcare Provider Details

I. General information

NPI: 1811342041
Provider Name (Legal Business Name): JENNIFER DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 SPRINGHILL MEMORIAL DR N
MOBILE AL
36608-1162
US

IV. Provider business mailing address

3610 SPRINGHILL MEMORIAL DR N
MOBILE AL
36608-1162
US

V. Phone/Fax

Practice location:
  • Phone: 225-141-0360
  • Fax: 251-410-3819
Mailing address:
  • Phone: 512-410-3651
  • Fax: 512-410-3819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-166368
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN370745
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: