Active NPI
Jesse E Davis, BS
- Physician Assistant
- Lynnwood, WA
National Provider Identifier
1649887548
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 3512 Serene Way
Lynnwood, WA 98087-5202 - Phone
- (425) 931-5717
- NPI assigned
- Sep 25, 2020
- Last updated
- Sep 25, 2020
- Sex
- Male
- 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 | Primary |
Addresses
Primary practice location
3512 Serene Way
Lynnwood, WA 98087-5202
Mailing address
3512 Serene Way
Lynnwood, WA 98087-5202
Phone (425) 931-5717
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600992000000",
"number": "1649887548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3512 SERENE WAY",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980875202",
"telephone_number": "425-931-5717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3512 SERENE WAY",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980875202",
"telephone_number": "425-931-5717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JESSE",
"middle_name": "E",
"name_prefix": "Mr.",
"credential": "BS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-25",
"last_updated": "2020-09-25",
"certification_date": "2020-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.