# JACQUELINE DAVIS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1871813550
- **Gender:** F
- **Credential:** APRN

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 3006612 | KY | Yes |
| 363L00000X | Nurse Practitioner | 49086 | KY | — |
| 363L00000X | Nurse Practitioner | 71003616A | IN | — |
| 363LF0000X | Family Nurse Practitioner | 3006612 | KY | — |

## Other

- **Enumeration date:** 06/04/2010
- **Last updated:** 06/01/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3006612 | LICENSE NUMBER | KY |
| 01 | — | 71003616A | LICENSE NUMBER | IN |
| 01 | — | K151030 | MEDICARE PTAN | KY |