Provider Demographics
NPI:1982630851
Name:DAVIS, JEFFREY LOUIS (PA-C)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LOUIS
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:NIXON
Mailing Address - State:NV
Mailing Address - Zip Code:89424-0227
Mailing Address - Country:US
Mailing Address - Phone:775-574-1018
Mailing Address - Fax:775-574-1028
Practice Address - Street 1:705 HWY 446
Practice Address - Street 2:
Practice Address - City:NIXON
Practice Address - State:NV
Practice Address - Zip Code:89424
Practice Address - Country:US
Practice Address - Phone:775-574-1018
Practice Address - Fax:775-574-1028
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085000573363A00000X
NVPA1345363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR20750Medicare UPIN
ILK13624Medicare ID - Type Unspecified