Healthcare Provider Details

I. General information

NPI: 1073694717
Provider Name (Legal Business Name): KATHY C DAVENPORT ARNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 N STRONG BLVD STE 300
MCALESTER OK
74501-3881
US

IV. Provider business mailing address

PO BOX 1146 1609 N STRONG BLVD SUITE 300
MCALESTER OK
74502-1146
US

V. Phone/Fax

Practice location:
  • Phone: 918-423-3400
  • Fax: 918-420-5051
Mailing address:
  • Phone: 918-423-3400
  • Fax: 918-420-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR0044227
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: