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NPI Code Detail

MEDICARE: KRYSTAL DAVENPORT

MEDICARE: KRYSTAL DAVENPORT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1831058866
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTAL DAVENPORT
Provider Business Mailing Address
First Line : PO BOX 33568
Second Line :
City : SAN DIEGO
State : CA
Zip : 92163-3568
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Provider Business Practice Location Address
First Line : 3760 S MASON RD STE 10
Second Line :
City : KATY
State : TX
Zip : 77450-7729
Country : US
Telephone Number : 855-223-7123
Fax Number : 619-374-7134
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2026
Last Update Date : 01/16/2026

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Directions to “ KRYSTAL DAVENPORT ” Practice Location

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