Healthcare Provider Details

I. General information

NPI: 1881472488
Provider Name (Legal Business Name): JD QUALITY NURSE PRACTITIONER SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 TRESSER BLVD FL 17
STAMFORD CT
06901-3436
US

IV. Provider business mailing address

110 OSBORN AVE
NEW HAVEN CT
06511-2804
US

V. Phone/Fax

Practice location:
  • Phone: 860-756-0455
  • Fax:
Mailing address:
  • Phone: 203-999-0135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JEWEL WALTERS-DAVIS
Title or Position: APRN
Credential: MSN, APRN, PMHNP-BC
Phone: 203-999-0135