Provider Demographics
NPI:1770092603
Name:DAVENPORT, SUMMER TEAHNA
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:TEAHNA
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 BIRCH
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-1020
Mailing Address - Country:US
Mailing Address - Phone:580-650-8097
Mailing Address - Fax:
Practice Address - Street 1:1501 LERA
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-2669
Practice Address - Country:US
Practice Address - Phone:580-774-9105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator