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General NPI Number Information
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NPI Number | 1801440763
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Entity Type | Individual
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Provider Name | JENNIFER SUE DAVIS MSN, APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 02/13/2020
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Provider Practice Location Address
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Address Line | 525 E 15TH ST
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City | PANAMA CITY
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State | FL
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Zip | 32405-5400
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Country | US
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Telephone | 850-522-4485
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Fax |
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Provider Business Mailing Address
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Address Line | 525 E 15TH ST
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City | PANAMA CITY
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State | FL
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Zip | 32405-5412
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Country | US
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Telephone | 231-499-8099
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Fax |
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN9510809
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11004531
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License Number State | FL
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