1275712986 NPI number — DR. JENNIFER LYNN DAVIS M.D.

Table of content: (NPI 1679921423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275712986 NPI number — DR. JENNIFER LYNN DAVIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
JENNIFER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275712986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
328 HEATHER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNSET BEACH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28468-4432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-306-6184
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TRU COMMUNITY CARE
Provider Second Line Business Practice Location Address:
2425 TRAILRIDGE DR EAST
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-449-7740
Provider Business Practice Location Address Fax Number:
303-604-5393
Provider Enumeration Date:
10/30/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  2008-01817 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0002X , with the licence number: 200801817 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)