Healthcare Provider Details

I. General information

NPI: 1568247773
Provider Name (Legal Business Name): LAUREN DAVENPORT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N WENDOVER RD
CHARLOTTE NC
28211-1064
US

IV. Provider business mailing address

3000 BIG OAK DR
CHARLOTTE NC
28210-6420
US

V. Phone/Fax

Practice location:
  • Phone: 704-817-8230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number253259
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5020877
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: