Healthcare Provider Details

I. General information

NPI: 1265085880
Provider Name (Legal Business Name): BRIAN ANTHONY DAVENPORT CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 AVALON AVE
MUSCLE SHOALS AL
35661-3283
US

IV. Provider business mailing address

PO BOX 2550
MUSCLE SHOALS AL
35662-2550
US

V. Phone/Fax

Practice location:
  • Phone: 256-386-0808
  • Fax: 256-389-3354
Mailing address:
  • Phone: 256-386-0808
  • Fax: 256-389-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-145737
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: