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General NPI Number Information
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NPI Number | 1053700849
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Entity Type | Individual
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Provider Name | JESSICA RENEE DAVIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 4221 S WESTERN AVE STE 5050
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City | OKLAHOMA CITY
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State | OK
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Zip | 73109-3499
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Country | US
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Telephone | 405-636-7900
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Fax | 405-644-5168
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Provider Business Mailing Address
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Address Line | 5300 N INDEPENDENCE AVE STE 280
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-5555
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Country | US
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Telephone | 405-636-7900
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Fax | 405-644-5168
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2454
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License Number State | OK
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