Provider Demographics
NPI:1811900095
Name:DAVENPORT, ROSEMARY E (NP)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:E
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:854 W JAMES M CAMPBELL BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4672
Mailing Address - Country:US
Mailing Address - Phone:931-490-7372
Mailing Address - Fax:931-490-7379
Practice Address - Street 1:1222 TROTWOOD AVE STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6404
Practice Address - Country:US
Practice Address - Phone:931-490-7372
Practice Address - Fax:931-490-7379
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6065363LA2100X, 363LF0000X
TN6065363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4136771OtherBCBST
TN3928039Medicaid
TN3710089Medicaid
TN3710089Medicaid
TNP00363382Medicare PIN
TNQ03295Medicare UPIN
TN3928039Medicaid
TNCE0561Medicare PIN
TN3710089Medicare PIN