MEDICARE: KIMBERLEY DAVENPORT MD

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
1	207R00000X	Internal Medicine Physician	W2830	TX
2	208M00000X	Hospitalist Physician	39770	SC
3	207R00000X	Internal Medicine Physician	39770	SC
4	208M00000X	Hospitalist Physician	W2830	TX
5	207R00000X	Internal Medicine Physician	LL39770	SC

General Provider Information

NPI Number	:	1790134633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEY DAVENPORT MD

Provider Business Mailing Address
First Line	:	4502 MEDICAL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4402
Country	:	US
Telephone Number	:	210-358-4000
Fax Number	:	210-358-8002

Provider Business Practice Location Address
First Line	:	701 GROVE RD FL 5
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-4210
Country	:	US
Telephone Number	:	864-455-4411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2016
Last Update Date	:	03/04/2026

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