Provider Demographics
NPI:1861696783
Name:DAVENPORT, LEIGH K (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:LEIGH
Middle Name:K
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:K
Other - Last Name:LAGRANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:789 CENTRAL AVENUE
Mailing Address - Street 2:BUSINESS OFFICE
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-740-4478
Mailing Address - Fax:603-740-2244
Practice Address - Street 1:10 MEMBERS WAY STE 400
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-5933
Practice Address - Country:US
Practice Address - Phone:603-740-2887
Practice Address - Fax:603-740-2886
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH941793133V00000X
NH423133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered