Provider Demographics
NPI:1891857181
Name:DAVENPORT, MOLLY MICHELLE (ARNP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:MICHELLE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 W GOWE ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5892
Mailing Address - Country:US
Mailing Address - Phone:253-833-7444
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:325 W GOWE ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5892
Practice Address - Country:US
Practice Address - Phone:253-777-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000091441041C0700X
390200000X
WAAP61002886363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program