Provider Demographics
NPI:1922601921
Name:DAVENPORT, ADAM TYLER (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:TYLER
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 MONTCLAIR RD APT E
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35213-2424
Mailing Address - Country:US
Mailing Address - Phone:334-398-1534
Mailing Address - Fax:
Practice Address - Street 1:3368 HIGHWAY 280 STE 130
Practice Address - Street 2:
Practice Address - City:ALEX CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3375
Practice Address - Country:US
Practice Address - Phone:256-234-2644
Practice Address - Fax:256-234-2704
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-148279363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care