Provider Demographics
NPI:1457800377
Name:DAVENPORT, LINDSAY JO (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:JO
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:62 CRESTWOOD TER
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-3719
Mailing Address - Country:US
Mailing Address - Phone:412-605-8843
Mailing Address - Fax:
Practice Address - Street 1:1228 E RUSHOLME ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2453
Practice Address - Country:US
Practice Address - Phone:563-421-7540
Practice Address - Fax:563-421-7549
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2023-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY021905363A00000X
PAMA058491363A00000X
NC0010-08667363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant