Jaclyn Davis

Key facts

NPI

1194375659

Entity type

Individual (NPI type 1)

Primary specialty

Attendant Care Provider 3747A0650X

Practice address

10526 SW Otis Walden Rd
Clarksville, FL 32430-2665

Phone

(850) 532-3244

NPI assigned

Sep 17, 2019

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 17, 2019.

{
    "created_epoch": "1568678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568678400000",
    "number": "1194375659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10526 SW OTIS WALDEN RD",
            "city": "CLARKSVILLE",
            "state": "FL",
            "postal_code": "324302665",
            "telephone_number": "850-532-3244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10526 SW OTIS WALDEN RD",
            "city": "CLARKSVILLE",
            "state": "FL",
            "postal_code": "324302665",
            "telephone_number": "850-532-3244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JACLYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-17",
        "last_updated": "2019-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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