Provider Demographics
NPI:1144334236
Name:DAVENPORT, RICHARD ALAN SR (CRNA, MS)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALAN
Last Name:DAVENPORT
Suffix:SR
Gender:M
Credentials:CRNA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HARTMAN DR
Mailing Address - Street 2:SUITE G,, #325
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2569
Mailing Address - Country:US
Mailing Address - Phone:615-294-9911
Mailing Address - Fax:615-444-0298
Practice Address - Street 1:102 HARTMANN DRIVE
Practice Address - Street 2:SUITE G, #325
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2516
Practice Address - Country:US
Practice Address - Phone:615-294-9911
Practice Address - Fax:615-444-0298
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN58326163WC0200X
TNAPN0000009203367500000X
KY1483A367500000X
SC3266367500000X
AL1-117383367500000X
FL9280506367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN36324201OtherMEDICAID - NASHVILLE GEN.
TN36324201OtherMEDICARE - NASHVILLE GEN.
TN36324201OtherMEDICAID - NASHVILLE GEN.