Debra L Davenport, MA, SPE

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PE 11334 Issued in TN

Practice address

198 W Main St
Camden, TN 38320-1609

Phone

(731) 584-1012

Fax

(731) 584-3102

NPI assigned

Mar 12, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831221944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12595 HIGHWAY 69A",
            "city": "BIG SANDY",
            "state": "TN",
            "postal_code": "382215066",
            "telephone_number": "731-584-1012",
            "fax_number": "731-584-3102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "198 W MAIN ST",
            "city": "CAMDEN",
            "state": "TN",
            "postal_code": "383201609",
            "telephone_number": "731-584-1012",
            "fax_number": "731-584-3102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "DEBRA",
        "middle_name": "L",
        "credential": "MA, SPE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TN",
            "license": "PE 11334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5441084",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Camden, TN
• Providers in Camden, TN by specialty
• Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.