Provider Demographics
NPI:1215474531
Name:DAVIS, JANA LYNN (MS, RD, CDE)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 CENTER STREET EXT APT 1207
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4653
Mailing Address - Country:US
Mailing Address - Phone:843-801-4686
Mailing Address - Fax:702-549-5309
Practice Address - Street 1:1481 CENTER STREET EXT APT 1207
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4653
Practice Address - Country:US
Practice Address - Phone:843-801-4686
Practice Address - Fax:702-549-5309
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1586133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered