Individual
JACQUELINE SMITH DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2001 TODAYS WOMAN AVE, WINSTON SALEM, NC 27105-5069
(336) 722-1818
(336) 722-1826
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5001629
NC
363LP0200X
Pediatric Nurse Practitioner
104882
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
181GT
BCBS OF NC
NC
01
—
196292
MEDCOST
NC
05
—
7003982
—
NC
01
—
9185097
AETNA
NC
01
—
NN2912
MEDICARE
NC
Enumeration date
01/25/2007
Last updated
05/08/2024
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