Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 676075 | TX |
NPI | 1225342363 |
---|---|
Provider Name | Mrs. Jessicah Amber Davis |
First Address | Burleson, TX 76028-8116 |
Second Address | Ft Worth, TX 76104-4110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2010 |
Last Update Date | 30/07/2010 |