Provider Demographics
NPI:1043010887
Name:DAVIS, JESSICA JAYNE (LMT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JAYNE
Last Name:DAVIS
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 DENNIS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-4713
Mailing Address - Country:US
Mailing Address - Phone:910-320-2550
Mailing Address - Fax:
Practice Address - Street 1:305 DENNIS RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-4713
Practice Address - Country:US
Practice Address - Phone:910-320-2550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22203225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist