Individual
MS. JENNIFER ELAINE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1111 RONALD REAGAN PKWY, AVON, IN 46123-7085
(317) 217-3000
(317) 963-5492
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003190A
IN
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264430H68
MEDICARE PTAN
IN
01
—
267030319
MEDICARE PTAN
IN
05
—
300051234
—
IN
Enumeration date
03/11/2010
Last updated
10/18/2023
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