Provider Demographics
NPI:1073151445
Name:DAVENPORT, ANDREW ALLEN (FNP-BC, NP-C)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:ALLEN
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:FNP-BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6823 SAINT CHARLES AVE BLDG 92
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5698
Mailing Address - Country:US
Mailing Address - Phone:504-865-5255
Mailing Address - Fax:
Practice Address - Street 1:6823 SAINT CHARLES AVE BLDG 92
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5698
Practice Address - Country:US
Practice Address - Phone:504-865-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA209249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily