Provider Demographics
NPI:1932424397
Name:DAVIS, JANA L (PA)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 HORIZON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7805
Mailing Address - Country:US
Mailing Address - Phone:972-772-5522
Mailing Address - Fax:469-402-1565
Practice Address - Street 1:3140 HORIZON RD STE 101
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7805
Practice Address - Country:US
Practice Address - Phone:972-772-5522
Practice Address - Fax:469-402-1565
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213054405Medicaid
TX213054402Medicaid
TX213054401Medicaid
TX213054403Medicaid
TX213054401Medicaid
TXTXB104935Medicare PIN
TXTXB123580Medicare PIN
TX213054403Medicaid