Provider Demographics
NPI:1265085880
Name:DAVENPORT, BRIAN ANTHONY (CRNP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ANTHONY
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2550
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35662-2550
Mailing Address - Country:US
Mailing Address - Phone:256-386-0808
Mailing Address - Fax:256-389-3554
Practice Address - Street 1:2400 AVALON AVE
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-3187
Practice Address - Country:US
Practice Address - Phone:256-386-0808
Practice Address - Fax:256-389-3354
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-145737363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner