Individual provider Active NPI

Nina Davenport

  • Clinical Social Worker
  • Vancouver, WA
National Provider Identifier
1699312116
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SC61021135 Issued in WA
Practice address
6926 NE Fourth Plain Blvd
Vancouver, WA 98661-7254
Phone
(360) 993-3000
NPI assigned
Dec 3, 2019
Last updated
May 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Social Worker 104100000X SC61021135 WA
Clinical Social Worker 1041C0700X SC61021135 WA Primary

Addresses

Primary practice location

6926 NE Fourth Plain Blvd
Vancouver, WA 98661-7254

Mailing address

1601 NE Fourth Plain Blvd
Mailstop V3Hbpc
Vancouver, WA 98661-7254

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240613000636 WA Practitioner - Clinical Social Worker 1355883729 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
PeacehealthGroup PAC ID 8820178288, 245 clinicians
PeacehealthGroup PAC ID 9739092065, 101 clinicians

Practice addresses (Care Compare)

505 NE 87TH Ave
Vancouver, WA 98664-1965

8716 E Mill Plain Blvd
Vancouver, WA 98664-2531
Phone (360) 256-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SC61021135WAMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Peacehealth CurrentSince Jun 7, 2024 Accepting new patients
Peacehealth CurrentSince Jun 7, 2024 Accepting new patients
Peacehealth CurrentSince Jun 7, 2024 Accepting new patients

Locations

1115 SE 164th Ave
Dept 364
Vancouver, WA 98683
Phone (360) 735-8100

201 NE Park Plaza Dr
Ste 145
Vancouver, WA 98684
Phone (360) 729-8383

400 NE Mother Joseph Pl
Vancouver, WA 98664
Phone (360) 514-2000

505 NE 87th Ave
Ste 301
Vancouver, WA 98664
Phone (360) 514-1854

8716 E Mill Plain Blvd
Vancouver, WA 98664
Phone (360) 514-4325

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1575331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1699312116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 NE FOURTH PLAIN BLVD",
            "address_2": "MAILSTOP V3HBPC",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986617254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6926 NE FOURTH PLAIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986617254",
            "telephone_number": "360-993-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "NINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-03",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WA",
            "license": "SC61021135",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "SC61021135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.