=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982088225
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAY DOWNING
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2015
-----------------------------------------------------
Last Update Date | 11/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 NORRIS PL
-----------------------------------------------------
City | SPENCER
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51301-3411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-580-4570
-----------------------------------------------------
Fax | 712-580-4573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 69 WESTVIEW DR
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51351-1370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-338-4147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | A106379
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------