Provider Demographics
NPI:1619225430
Name:DAVENPORT-FOX, ELIZABETH CORLEY (DNP, APRN, ANP-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CORLEY
Last Name:DAVENPORT-FOX
Suffix:
Gender:F
Credentials:DNP, APRN, ANP-BC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CORLEY
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, APRN, ANP-BC
Mailing Address - Street 1:517 PUCKETT FERRY RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-8698
Mailing Address - Country:US
Mailing Address - Phone:864-388-4325
Mailing Address - Fax:864-388-4327
Practice Address - Street 1:517 PUCKETT FERRY RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649
Practice Address - Country:US
Practice Address - Phone:864-388-4325
Practice Address - Fax:864-388-4327
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17952363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health