Healthcare Provider Details

I. General information

NPI: 1770202152
Provider Name (Legal Business Name): JENNIFER DAVISON PSYCH NP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 W AIRLINE HWY
LA PLACE LA
70068-3817
US

IV. Provider business mailing address

PO BOX 24105
NEW ORLEANS LA
70184-4105
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-3344
  • Fax: 504-930-4545
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER DAVISON
Title or Position: OWNER
Credential: PMHNP
Phone: 504-930-4545