Provider Demographics
NPI:1710281399
Name:DAVENPORT-CAMPBELL, RACHEL (APRN)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:DAVENPORT-CAMPBELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4071 TATES CREEK CENTRE DR
Mailing Address - Street 2:STE 202
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3094
Mailing Address - Country:US
Mailing Address - Phone:606-330-7370
Mailing Address - Fax:606-330-7315
Practice Address - Street 1:192 LONDON SHOPPING CTR
Practice Address - Street 2:STE 2
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3015
Practice Address - Country:US
Practice Address - Phone:606-330-7370
Practice Address - Fax:606-330-7315
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1102941363LF0000X
KY3006693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100215250Medicaid
KY7100215250Medicaid