Provider Demographics
NPI:1649887548
Name:DAVIS, JESSE E (BS)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:E
Last Name:DAVIS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
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Mailing Address - Street 1:3512 SERENE WAY
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-5202
Mailing Address - Country:US
Mailing Address - Phone:425-931-5717
Mailing Address - Fax:
Practice Address - Street 1:3512 SERENE WAY
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-5202
Practice Address - Country:US
Practice Address - Phone:425-931-5717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant