Healthcare Provider Details

I. General information

NPI: 1982935896
Provider Name (Legal Business Name): JENNY LORI DAVENPORT M.H.S., R.D., L.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2010
Last Update Date: 01/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 HARSHAW RD
MURPHY NC
28906-7035
US

IV. Provider business mailing address

PO BOX 1146
MURPHY NC
28906-1146
US

V. Phone/Fax

Practice location:
  • Phone: 828-837-6837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberL003396
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number985075
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: