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1487206306 NPI number — ANDREA LYNN DAVENPORT MS, FNP-BC

NPI Number: 1487206306
Health Care Provider/Practitioner: ANDREA LYNN DAVENPORT MS, FNP-BC

Information about “1487206306” NPI (ANDREA LYNN DAVENPORT MS, FNP-BC) exists in 1487206306 in HTML format HTML  |  1487206306 in plain Text format TXT  |  1487206306 in PDF (Portable Document Format) PDF  |  1487206306 in an XML format XML  formats.

NPI Number : 1487206306 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1487206306",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DAVENPORT",
    "FirstName": "ANDREA",
    "MiddleName": "LYNN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "MS, FNP-BC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WILSON",
    "OtherFirstName": "ANDREA",
    "OtherMiddleName": "LYNN",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "RN",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4264 S 430 E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "KINGMAN",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "47952-8037",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "765-376-2320",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "703 W PARK ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CAYUGA",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "47928-8207",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "765-492-9042",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/11/2019",
    "LastUpdateDate": "07/11/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "71009111A",
        "LicenseNumberStateCode": "IN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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