Provider Demographics
NPI:1215979752
Name:DAVENPORT, CHRISTINA A (RD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:A
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:A
Other - Last Name:SHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15925 COUNTRY LN W
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-9524
Mailing Address - Country:US
Mailing Address - Phone:302-943-2135
Mailing Address - Fax:
Practice Address - Street 1:2200 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66622-0001
Practice Address - Country:US
Practice Address - Phone:785-350-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDN-0000246133V00000X
MO2010041003132700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes132700000XDietary & Nutritional Service ProvidersDietary Manager
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered