Provider Demographics
NPI:1821336017
Name:DAVENPORT, ROSEMARIE (MHPP III)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:MHPP III
Other - Prefix:
Other - First Name:ROSEMARIE
Other - Middle Name:
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1567 MC 5002
Mailing Address - Street 2:
Mailing Address - City:YELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72687-7929
Mailing Address - Country:US
Mailing Address - Phone:619-302-4541
Mailing Address - Fax:
Practice Address - Street 1:319 HIGHWAY 14 SOUTH
Practice Address - Street 2:
Practice Address - City:YELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72687
Practice Address - Country:US
Practice Address - Phone:866-308-9927
Practice Address - Fax:870-449-5178
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator