Provider Demographics
NPI:1548979081
Name:DAVIS, JENNIFER RENEE (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RENEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1491 S SUNNYLANE RD
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-3037
Mailing Address - Country:US
Mailing Address - Phone:405-437-2240
Mailing Address - Fax:661-231-3153
Practice Address - Street 1:1491 S SUNNYLANE RD
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3037
Practice Address - Country:US
Practice Address - Phone:405-437-2240
Practice Address - Fax:661-231-3153
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK202343163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse