MEDICARE: KATI DAVENPORT APRN,BC

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	363L00000X	Nurse Practitioner	102083	OK
2	363L00000X	Nurse Practitioner	641318	TX
3	363L00000X	Nurse Practitioner	AP115103	TX

General Provider Information

NPI Number	:	1972519809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATI DAVENPORT APRN,BC

Provider Business Mailing Address
First Line	:	1908 N LAURENT ST STE 410
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-5469
Country	:	US
Telephone Number	:	361-572-0333
Fax Number	:	361-371-7090

Provider Business Practice Location Address
First Line	:	800 W CENTRAL TEXAS EXPY STE 205
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-1996
Country	:	US
Telephone Number	:	254-618-1080
Fax Number	:	254-618-1065

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	08/05/2021

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