Active NPI
Jenna Logan Davison, PA
- Physician Assistant
- Fort Worth, TX
National Provider Identifier
1417293960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA08103
- Practice address
- 7801 Oakmont Blvd
Ste 101
Ft Worth, TX 76132-4204 - Phone
- (817) 263-0007
- Fax
- (817) 263-1118
- NPI assigned
- Jan 2, 2013
- Last updated
- Nov 17, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA08103 | TX | Primary |
Addresses
Primary practice location
7801 Oakmont Blvd
Ste 101
Ft Worth, TX 76132-4204
Mailing address
7801 Oakmont Blvd
Ste 101
Ft Worth, TX 76132-4204
Phone (817) 263-0007
Other names 1
- Jenna Logan Brewer
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Interoperability endpoints
- jenna.brewer@direct.emm.nextgenshare.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Endocrinology, Diabetes & Metabolism Physician
- Fort Worth, TX
- NPI 1871639757
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1357084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605571200000",
"number": "1417293960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7801 OAKMONT BLVD",
"address_2": "STE 101",
"city": "FT WORTH",
"state": "TX",
"postal_code": "761324204",
"telephone_number": "817-263-0007",
"fax_number": "817-263-1118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7801 OAKMONT BLVD",
"address_2": "STE 101",
"city": "FT WORTH",
"state": "TX",
"postal_code": "761324204",
"telephone_number": "817-263-0007",
"fax_number": "817-263-1118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVISON",
"first_name": "JENNA",
"middle_name": "LOGAN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-01-02",
"last_updated": "2020-11-17",
"certification_date": "2020-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA08103",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JENNA",
"last_name": "BREWER",
"middle_name": "LOGAN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.