Healthcare Provider Details

I. General information

NPI: 1972519809
Provider Name (Legal Business Name): KATI DAVENPORT APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W CENTRAL TEXAS EXPY STE 205
HARKER HEIGHTS TX
76548-1996
US

IV. Provider business mailing address

1908 N LAURENT ST STE 410
VICTORIA TX
77901-5469
US

V. Phone/Fax

Practice location:
  • Phone: 254-618-1080
  • Fax: 254-618-1065
Mailing address:
  • Phone: 361-572-0333
  • Fax: 361-371-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number102083
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number641318
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP115103
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: