Healthcare Provider Details

I. General information

NPI: 1437027976
Provider Name (Legal Business Name): INNER ROOTS BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N MAIN ST STE 107
LORETTO TN
38469-2356
US

IV. Provider business mailing address

123 N MAIN ST STE 107
LORETTO TN
38469-2356
US

V. Phone/Fax

Practice location:
  • Phone: 931-223-6659
  • Fax:
Mailing address:
  • Phone: 931-223-6659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NIKKI LEE DAVENPORT
Title or Position: OWNER & MANAGING MEMBER
Credential: PMHNP-BC, FNP-C, DNP
Phone: 931-242-9298