NPIMap

Individual provider Active NPI

Jessica Lynn Davis, N.P.

  • Acute Care Nurse Practitioner
  • Wyandotte, MI
National Provider Identifier
1003142118
Registry record updated Apr 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
4704245661 Issued in MI
Practice address
2025 Ford Ave
Wyandotte, MI 48192-2312
Phone
(734) 281-3080
Fax
(734) 281-8815
NPI assigned
Oct 23, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Nurse Practitioner 363LC0200X 4704245661 MI
Acute Care Nurse Practitioner 363LA2100X 4704245661 MI Primary

Addresses

Primary practice location

2025 Ford Ave
Wyandotte, MI 48192-2312

Mailing address

2025 Ford Ave
Wyandotte, MI 48192-2312
Phone (734) 281-3080

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jtkach59040@direct.hfhs.org Henry Ford Wyandotte Hospital

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250422001444 MI Practitioner - Nurse Practitioner 9830402452 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Wayne State University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Wyandotte HospitalGroup PAC ID 2264334499, 194 clinicians

Practice addresses (Care Compare)

2333 Biddle Ave
Wyandotte, MI 48192-4668
Phone (734) 246-8895

Hospital & facility affiliations

  • Wyandotte Hospital and Medical Center Hospital, Wyandotte, MI, CCN 230146

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Wyandotte Hospital Current Accepting new patients
Henry Ford Wyandotte Hospital CurrentSince Apr 11, 2025 Accepting new patients
Henry Ford Wyandotte Hospital CurrentSince Apr 11, 2025 Accepting new patients
Henry Ford Wyandotte Hospital Past Accepting new patients

Locations

2333 Biddle Ave
Wyandotte, MI 48192
Phone (734) 246-6000

2070 Biddle Ave
Ste 2
Wyandotte, MI 48192
Phone (734) 284-7482

Interoperability endpoints

  • Direct secure messaging: jtkach59040@direct.hfhs.org

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744329600000",
    "number": "1003142118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2025 FORD AVE",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481922312",
            "telephone_number": "734-281-3080",
            "fax_number": "734-281-8815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 FORD AVE",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481922312",
            "telephone_number": "734-281-3080",
            "fax_number": "734-281-8815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-23",
        "last_updated": "2025-04-11",
        "certification_date": "2025-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LC0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": "MI",
            "license": "4704245661",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704245661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jtkach59040@direct.hfhs.org",
            "affiliation": "Y",
            "affiliationName": "Henry Ford Wyandotte Hospital",
            "address_1": "2333 Biddle St",
            "city": "Wyandotte",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481924668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Wyandotte, MI

Sources for this page

Verify at the official NPI Registry.