Healthcare Provider Details

I. General information

NPI: 1871301010
Provider Name (Legal Business Name): JESSICA RAE KIRKEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA RAE DAVIS

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13720 OLD SAINT AUGUSTINE RD STE 1
JACKSONVILLE FL
32258-7415
US

IV. Provider business mailing address

PO BOX 746638
ATLANTA GA
30374-6638
US

V. Phone/Fax

Practice location:
  • Phone: 904-288-5550
  • Fax: 904-390-7453
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11036059
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11036059
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: