Mackenzie Davenport, AT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2601002811 Issued in MI

Practice address

6191 Kraft Ave SE
Grand Rapids, MI 49512-9396

Phone

(616) 871-6738

NPI assigned

Jan 24, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

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": "1485216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700092800000",
    "number": "1427595842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6130 WOODFIELD DR SE APT 2",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495488516",
            "telephone_number": "574-274-6598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6191 KRAFT AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495129396",
            "telephone_number": "616-871-6738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "MACKENZIE",
        "credential": "AT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-24",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CO",
            "license": "AT.0002319",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IN",
            "license": "36003148A",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MI",
            "license": "2601002811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Joyce Dattadeen, LLPC
• Kimberly Kaye Daugherty, PHARMD
• Alison Dault, LMSW
• Laurie J Daum, MD
• Annie Daus, MA, CCC-SLP
• David Barney PLLC (David Barney Family Medicine)
• David D Brelinski III, PLLC (Grand Rapids Spine & Sport)
• David G Frye PC
• David G. Raffo MD PLLC
• David Lamberts, DDS,PC

• Athletic Trainer in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Athletic Trainer in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; 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.