Deanna L Davenport, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN127022 Issued in GA

Practice address

401 Kellings Farm Rd
East Carondelet, IL 62240-1241

Phone

(678) 517-4802

NPI assigned

Dec 4, 2006

Last updated

Nov 15, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community Care Health Network LLC

  dba Matrix Medical Network

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1619368842

  GA

  Medicare reassignment NPD
• Rediclinic LLC

  • Clinic/Center
  • Owasso, OK
  • NPI 1528107141
  NPD (past)
• Take Care Health Georgia, P.C.

  • Family Nurse Practitioner
  • Kennesaw, GA
  • NPI 1043409964
  NPD (past)

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763164800000",
    "number": "1467510644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 KELLINGS FARM RD",
            "city": "EAST CARONDELET",
            "state": "IL",
            "postal_code": "622401241",
            "telephone_number": "678-517-4802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 KELLINGS FARM RD",
            "city": "EAST CARONDELET",
            "state": "IL",
            "postal_code": "622401241",
            "telephone_number": "678-517-4802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "DEANNA",
        "middle_name": "L",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2025-11-15",
        "certification_date": "2025-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN127022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Charles Ruiz, M.D.

• Nurse Practitioner in East Carondelet, IL
• Providers in East Carondelet, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.