Individual
JEREMY P DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ACNP-BC
Contact information
Practice address
3217 MABEL ST, SHREVEPORT, LA 71103-4022
(318) 631-9121
(318) 631-9126
Mailing address
3217 MABEL ST, SHREVEPORT, LA 71103-4022
(318) 631-9121
(318) 631-9126
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
AP07028
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2318969
—
LA
01
—
AP07028
STATE LICENSE
LA
Enumeration date
10/16/2012
Last updated
08/11/2022
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