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General NPI Number Information
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NPI Number | 1861918344
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Entity Type | Individual
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Provider Name | LISA MICHELE DAVENPORT NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 1950 ASPEN AVE
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City | LUBBOCK
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State | TX
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Zip | 79404-1211
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Country | US
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Telephone | 806-740-1421
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Fax | 806-747-5491
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Provider Business Mailing Address
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Address Line | 904 AVENUE O
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City | LUBBOCK
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State | TX
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Zip | 79401-3924
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Country | US
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Telephone | 806-766-0273
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Fax | 806-766-0250
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP134875
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP134875
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License Number State | TX
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