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NPI Code Detail

MEDICARE: KATHERINE ALEXIS DAVENPORT MS, RD, LD

MEDICARE: KATHERINE ALEXIS DAVENPORT MS, RD, LD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianDI1539ME

General Provider Information

NPI Number : 1164048260
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE ALEXIS DAVENPORT MS, RD, LD
Provider Business Mailing Address
First Line : 105 HARVEST ROAD
Second Line :
City : HOLDEN
State : ME
Zip : 04429
Country : US
Telephone Number : 207-944-3139
Fax Number :
Provider Business Practice Location Address
First Line : 300 MAIN ST
Second Line :
City : LEWISTON
State : ME
Zip : 04240-7027
Country : US
Telephone Number : 207-795-8368
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2020
Last Update Date : 12/08/2025

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