Individual provider Active NPI

Jennifer Doby Davis, AGNP-C

  • Nurse Practitioner
  • Winston Salem, NC
National Provider Identifier
1508107707
Registry record updated Oct 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5006102 Issued in NC
Practice address
186 Kimel Park Dr
Winston Salem, NC 27103-6946
Phone
(336) 277-2000
Fax
(336) 277-2050
NPI assigned
Mar 13, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5006102 NC Primary

Addresses

Primary practice location

186 Kimel Park Dr
Winston Salem, NC 27103-6946

Mailing address

PO Box 751803
Charlotte, NC 28275-1803
Phone (336) 277-2000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jdavis39225@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130813000361 NC Practitioner - Nurse Practitioner 7810139391 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

1710 Kernersville Medical Pkwy
Suite 205
Kernersville, NC 27284-7156
Phone (336) 983-4500

Hospital & facility affiliations

  • Novant Health Forsyth Medical Center Hospital, Winston-Salem, NC, CCN 340014

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5006102NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Nov 1, 2021 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Dec 5, 2017 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Dec 5, 2017 Accepting new patients
Forsyth Memorial Hospital, Inc. Current Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Forsyth Memorial Hospital, Inc CurrentSince May 22, 2013 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Forsyth Memorial Hospital, Inc Past Accepting new patients

Locations

125 Baldwin Ave
Ste 200
Charlotte, NC 28204
Phone (704) 384-5043

100 Johnson Ridge Medical Park
Elkin, NC 28621
Phone (336) 245-2100

1226 Eastchester Dr
#100
High Point, NC 27265
Phone (336) 481-8540

1710 Kernersville Medical Pkwy
Ste 205
Kernersville, NC 27284
Phone (336) 983-4500

291 Broad St
Kernersville, NC 27284
Phone (336) 993-8181

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

390 W Salem Ave
Winston Salem, NC 27101
Phone (336) 721-2375

186 Kimel Park Dr
Winston Salem, NC 27103
Phone (336) 277-2000

Organizations & group practices 8

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 1

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": "1363132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1508107707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "336-277-2000",
            "fax_number": "336-277-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "186 KIMEL PARK DR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271036946",
            "telephone_number": "336-277-2000",
            "fax_number": "336-277-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JENNIFER",
        "middle_name": "DOBY",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-13",
        "last_updated": "2020-10-28",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5006102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jdavis39225@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "186 Kimel Park Dr",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271036946",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.