Provider Demographics
NPI:1285241802
Name:DAVIS, JESTINE ALEXANDRA
Entity type:Individual
Prefix:MS
First Name:JESTINE
Middle Name:ALEXANDRA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7850 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-7380
Mailing Address - Country:US
Mailing Address - Phone:910-747-3130
Mailing Address - Fax:
Practice Address - Street 1:7850 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-7380
Practice Address - Country:US
Practice Address - Phone:910-747-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator