Healthcare Provider Details

I. General information

NPI: 1144334236
Provider Name (Legal Business Name): RICHARD ALAN DAVENPORT SR. C.R.N.A., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HARTMANN DRIVE SUITE G, #325
LEBANON TN
37087-2516
US

IV. Provider business mailing address

102 HARTMAN DR SUITE G,, #325
LEBANON TN
37087-2569
US

V. Phone/Fax

Practice location:
  • Phone: 615-294-9911
  • Fax: 615-444-0298
Mailing address:
  • Phone: 615-294-9911
  • Fax: 615-444-0298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number58326
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN0000009203
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1483A
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3266
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-117383
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9280506
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: