Healthcare Provider Details

I. General information

NPI: 1215979752
Provider Name (Legal Business Name): CHRISTINA A DAVENPORT RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA A SHELL

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 SW GAGE BLVD
TOPEKA KS
66622-0001
US

IV. Provider business mailing address

15925 COUNTRY LN W
PLATTE CITY MO
64079-9524
US

V. Phone/Fax

Practice location:
  • Phone: 785-350-3111
  • Fax:
Mailing address:
  • Phone: 302-943-2135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number2010041003
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN-0000246
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: