Provider Demographics
NPI:1194089763
Name:DAVIS, JAMA BRADFORD (APN)
Entity type:Individual
Prefix:
First Name:JAMA
Middle Name:BRADFORD
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BURTON HILLS BLVD
Mailing Address - Street 2:STE 175
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6403
Mailing Address - Country:US
Mailing Address - Phone:615-864-8703
Mailing Address - Fax:615-864-7565
Practice Address - Street 1:303 BANCARIO
Practice Address - Street 2:SUITE 1
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-2825
Practice Address - Country:US
Practice Address - Phone:870-739-8670
Practice Address - Fax:870-739-8706
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003724363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR193487758Medicaid