Basic Information
| Provider Information | |||||||||
| NPI: | 1447429386 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 451 HIGHWAY 13 S | ||||||||
| Address2: | |||||||||
| City: | WAVERLY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371852109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312960211 | ||||||||
| FaxNumber: | 9312960199 | ||||||||
| Practice Location | |||||||||
| Address1: | 186 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383201618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7315843151 | ||||||||
| FaxNumber: | 7315843168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2008 | ||||||||
| LastUpdateDate: | 11/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 13297 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.