Provider Demographics
NPI:1487291035
Name:DAVIS, JENNIFER (PRS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 KENTON ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-2408
Mailing Address - Country:US
Mailing Address - Phone:513-221-1564
Mailing Address - Fax:
Practice Address - Street 1:3009 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2419
Practice Address - Country:US
Practice Address - Phone:513-751-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist