Healthcare Provider Details

I. General information

NPI: 1518470285
Provider Name (Legal Business Name): STEPHANIE LEA DAVENPORT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 24TH ST
KANSAS CITY MO
64108-2776
US

IV. Provider business mailing address

1555 NE RICE RD
LEES SUMMIT MO
64086-6034
US

V. Phone/Fax

Practice location:
  • Phone: 816-965-1151
  • Fax:
Mailing address:
  • Phone: 816-966-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2011018035
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: