Healthcare Provider Details

I. General information

NPI: 1255531661
Provider Name (Legal Business Name): JENNIFER LYNN DAVIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN YOUNG

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 TIETON DR
YAKIMA WA
98902-3761
US

IV. Provider business mailing address

240 LEININGER DR
YAKIMA WA
98901-9349
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-8000
  • Fax:
Mailing address:
  • Phone: 509-833-1508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN60074385
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP6075512
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: