Provider Demographics
NPI:1497015499
Name:DAVENPORT, PETER MILO
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:MILO
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DBA ANGELS
Other - Middle Name:HELPING
Other - Last Name:HANDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:116 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3478
Mailing Address - Country:US
Mailing Address - Phone:931-220-7449
Mailing Address - Fax:270-466-5075
Practice Address - Street 1:116 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3478
Practice Address - Country:US
Practice Address - Phone:931-220-7449
Practice Address - Fax:270-466-5075
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL0000000009366385H00000X, 374U00000X, 376J00000X
KYD99-281-661172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care
No374U00000XNursing Service Related ProvidersHome Health Aide
No172A00000XOther Service ProvidersDriver