Active NPI
Jacqueline June Davis, NURSE PRACTITIONER
- Family Nurse Practitioner
- Moraine, OH
National Provider Identifier
1972886943
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- COA. 12542-NP
- Practice address
- 2912 Springboro Rd
Moraine, OH 45439-1674 - Phone
- (937) 297-8999
- Fax
- (937) 277-8618
- NPI assigned
- Sep 26, 2011
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | COA. 12542-NP | OH | Primary |
Addresses
Primary practice location
2912 Springboro Rd
Moraine, OH 45439-1674
Mailing address
6544 Riverbend Dr
Dayton, OH 45415-2676
Phone (937) 416-3400
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0054352 | Medicaid | OH | |
| 000000742437 | Other | OH | ANTHEM BCBS OHIO |
| 421534506182 | Other | OH | CARESROUCE OHIO |
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)
- Enrolled
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| COA. 12542-NP | OH | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Medical Group | Past | Accepting new patients | |
| Providence Medical Group | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Podiatrist
- Moraine, OH
- NPI 1811304595
-
- Family Medicine Physician
- Dayton, OH
- NPI 1972533149
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354665600000",
"number": "1972886943",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6544 RIVERBEND DR",
"city": "DAYTON",
"state": "OH",
"postal_code": "454152676",
"telephone_number": "937-416-3400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2912 SPRINGBORO RD",
"city": "MORAINE",
"state": "OH",
"postal_code": "454391674",
"telephone_number": "937-297-8999",
"fax_number": "937-277-8618"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JACQUELINE",
"middle_name": "JUNE",
"name_prefix": "Mrs.",
"credential": "NURSE PRACTITIONER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-26",
"last_updated": "2012-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OH",
"license": "COA. 12542-NP",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0054352",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS OHIO",
"identifier": "000000742437",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARESROUCE OHIO",
"identifier": "421534506182",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moraine, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.