Provider Demographics
NPI:1558145516
Name:DAVENPORT, COURTNEY DEANNE (DNP)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:DEANNE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-1941
Mailing Address - Country:US
Mailing Address - Phone:417-576-7869
Mailing Address - Fax:
Practice Address - Street 1:1173 E HINES ST
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-1277
Practice Address - Country:US
Practice Address - Phone:417-735-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023036518363LG0600X
MO2018034729363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology