Healthcare Provider Details

I. General information

NPI: 1679282461
Provider Name (Legal Business Name): JENNIFER JAMIE DAVIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15675 HANOVER FALLS DR
BENNINGTON NE
68007-3368
US

IV. Provider business mailing address

15675 HANOVER FALLS DR
BENNINGTON NE
68007-3368
US

V. Phone/Fax

Practice location:
  • Phone: 531-559-6000
  • Fax: 531-559-6050
Mailing address:
  • Phone: 531-559-6000
  • Fax: 531-559-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2855
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: