Provider Demographics
NPI:1578883302
Name:DAVENPORT, AMANDA SUE (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:SUE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:301 GORDON GUTMANN BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3766
Mailing Address - Country:US
Mailing Address - Phone:812-282-6114
Mailing Address - Fax:812-650-5313
Practice Address - Street 1:301 GORDON GUTMANN BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3764
Practice Address - Country:US
Practice Address - Phone:812-282-6114
Practice Address - Fax:812-280-2142
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47103207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01076341AOtherMD LICENSURE
KY47103OtherKY MEDICAL LICENSE NUMBER