Breanna Davenport, MBA, VATL, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

0126001832 Issued in VA

Practice address

812 Thompson Dr
C/O Bre Davenport
Abingdon, VA 24210-2346

Phone

(276) 206-6729

NPI assigned

Oct 13, 2016

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Business Administration

State licenses

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

{
    "created_epoch": "1476316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476316800000",
    "number": "1750831764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10774 FOREST HILL DR",
            "city": "GLADE SPRING",
            "state": "VA",
            "postal_code": "243405246",
            "telephone_number": "276-206-6729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 THOMPSON DR",
            "address_2": "C/O BRE DAVENPORT",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242102346",
            "telephone_number": "276-206-6729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "BREANNA",
        "credential": "MBA, VATL, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-13",
        "last_updated": "2016-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "VA",
            "license": "0126001832",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglas David Dalton II, PA-C
• Stephanie Blaylock Danko, M.S. CCC-SLP
• Megan Lee Daugherty
• Patrick Wayne Daugherty, PHARMD
• Brandy Davenport, AU.D., CCC-A
• Ephraim David, DO
• Angela Davis, P.T.
• Daniel Travis Davis, LPC
• Rebekah Christine Davis, FNP
• Timothy Mark Davis, MD

• Athletic Trainer in Abingdon, VA
• Providers in Abingdon, VA by specialty
• Athletic Trainer in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2016; 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.