Holly Davenport

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

RT692702 Issued in OH

Practice address

612 E 185TH St
Cleveland, OH 44119-1766

Phone

(216) 659-7610

NPI assigned

Feb 28, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1740700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744070400000",
    "number": "1417754193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1073 E 146TH ST",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441103315",
            "telephone_number": "216-738-2265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 E 185TH ST",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441191766",
            "telephone_number": "216-659-7610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "HOLLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-28",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OH",
            "license": "RT692702",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Augustine Dautey
• Pooja Rajesh Dave, MD/MPH
• Dave'S Supermarket Inc.
• Dave'S Supermarkets Inc
• Veronica Davenport Wilson, DECEMBER 10TH, 2020
• Trinisa Davenport
• Tyraya Davenport
• Westine Davenport, INDEPENDENT PROVIDER
• Daves Supermarket Inc
• Alexander Daves, D.O.

• Case Manager/Care Coordinator in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Case Manager/Care Coordinator in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.