Andrea Lynn Davenport, MS, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71009111A Issued in IN

Practice address

703 W Park St
Cayuga, IN 47928-8207

Phone

(765) 492-9042

NPI assigned

Jul 11, 2019

Last updated

Jul 11, 2019By 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

Other names 1

• Miss Andrea Lynn Wilson Former name

Medicare fee-for-service enrollment

Enrolled in IN

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

Master of Science, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: andrea.davenport.1@23284.direct.athenahealth.com

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.

• Valley Professionals Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Clinton, IN
  • NPI 1104006253
  Medicare reassignment NPD
• Valley Professionals Community Health Center Inc

  dba VPCHC-Clinton Dental

  • Federally Qualified Health Center (FQHC)
  • Clinton, IN
  • NPI 1972312973
  NPD

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

{
    "created_epoch": "1562803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562803200000",
    "number": "1487206306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4264 S 430 E",
            "city": "KINGMAN",
            "state": "IN",
            "postal_code": "479528037",
            "telephone_number": "765-376-2320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "703 W PARK ST",
            "city": "CAYUGA",
            "state": "IN",
            "postal_code": "479288207",
            "telephone_number": "765-492-9042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "ANDREA",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "MS, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-11",
        "last_updated": "2019-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71009111A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDREA",
            "last_name": "WILSON",
            "middle_name": "LYNN",
            "prefix": "MISS",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeffrey Kent Binder, DC
• Zakary Bushue, LCSW
• Megan Castaneda, MSW, LSW
• Harrell's Home Healthcare, LLC
• North Vermillion Comm. School Corporation
• Parke Clinic, PC
• Janet Ann Rutter, LMHC
• Erik P Southard, D-NP

• Family Nurse Practitioner in Cayuga, IN
• Providers in Cayuga, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; 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.