Healthcare Provider Details

I. General information

NPI: 1134736135
Provider Name (Legal Business Name): JENNAYA LYNN DAVIS AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N ELAM AVE
GREENSBORO NC
27403-1129
US

IV. Provider business mailing address

3102 AMIDON DR
GREENSBORO NC
27410-9440
US

V. Phone/Fax

Practice location:
  • Phone: 336-274-1114
  • Fax:
Mailing address:
  • Phone: 336-686-9867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberDAVI-XGHVT
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: