Provider Demographics
NPI:1932610367
Name:DAVENPORT, NIKKI LEE (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:LEE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:TN
Mailing Address - Zip Code:38469-2145
Mailing Address - Country:US
Mailing Address - Phone:931-242-9298
Mailing Address - Fax:
Practice Address - Street 1:120 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5510
Practice Address - Country:US
Practice Address - Phone:256-320-7781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3-001771363LF0000X, 363LP0808X
TN23085363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily