Provider Demographics
NPI:1811260649
Name:DAVENPORT, KAREN MICHELLE (APN ,ACNP-BC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MICHELLE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:APN ,ACNP-BC
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Other - First Name:
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Mailing Address - Street 1:605 GLENWOOD DRIVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2720
Mailing Address - Country:US
Mailing Address - Phone:423-629-4220
Mailing Address - Fax:423-629-4091
Practice Address - Street 1:605 GLENWOOD DR
Practice Address - Street 2:SUITE 404
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1108
Practice Address - Country:US
Practice Address - Phone:423-629-7220
Practice Address - Fax:423-629-4091
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2016-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN16430363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ006688Medicaid
TN6021086OtherBCBS OF TENNESSEE
TNQ006688Medicaid