Healthcare Provider Details

I. General information

NPI: 1740757608
Provider Name (Legal Business Name): DAVEN RICHELLE MANSFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 W MAIN ST
LEXINGTON KY
40508-2065
US

IV. Provider business mailing address

526 MEADOWBROOK RD
RICHMOND KY
40475-9581
US

V. Phone/Fax

Practice location:
  • Phone: 855-591-0092
  • Fax:
Mailing address:
  • Phone: 859-556-2736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: