Individual
JACQUELINE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1804 E 10TH ST, JEFFERSONVILLE, IN 47130-6016
(812) 288-2488
(812) 288-6603
Mailing address
200 CLINIC DRIVEV, MADISONVILLE, KY 42431-1661
(270) 824-3682
(270) 824-3675
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3006612
KY
363L00000X
Nurse Practitioner
49086
KY
363L00000X
Nurse Practitioner
71003616A
IN
363LF0000X
Family Nurse Practitioner
3006612
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3006612
LICENSE NUMBER
KY
01
—
71003616A
LICENSE NUMBER
IN
01
—
K151030
MEDICARE PTAN
KY
Enumeration date
06/04/2010
Last updated
06/01/2017
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