Provider Demographics
NPI:1932610367
Name:DAVENPORT, NIKKI LEE (FNP)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:LEE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:TN
Mailing Address - Zip Code:38469-2145
Mailing Address - Country:US
Mailing Address - Phone:931-242-9298
Mailing Address - Fax:
Practice Address - Street 1:106 S MILITARY ST
Practice Address - Street 2:
Practice Address - City:LORETTO
Practice Address - State:TN
Practice Address - Zip Code:38469-2100
Practice Address - Country:US
Practice Address - Phone:931-853-4622
Practice Address - Fax:931-853-4621
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23085363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily