Lana J Davenport MD PLC

Organization Active NPI Psychiatry Physician · Russell, KY

NPI 1992037337 · NPPES record last updated Jun 27, 2011

Key facts

NPI
1992037337
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatry Physician 2084P0800X
License
42000 (KY)
Legal business name
LANA J DAVENPORT MD PLC
Practice address
1451 Diederich Blvd
Russell, KY 41169-1718
Phone
(606) 547-4536
Fax
(866) 511-5587
NPI assigned
Feb 10, 2010
Organization subpart
No

Authorized official

Name
Lana J Davenport, MD
Title
Owner
Phone
(606) 547-4536

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician
Group: 193400000X SINGLE SPECIALTY GROUP
2084P0800X 42000 KY Yes

Addresses

Primary practice location

1451 Diederich Blvd
Russell, KY 41169-1718

Mailing address

1451 Diederich Blvd
Russell, KY 41169-1718
Phone (606) 547-4536

Other identifiers

IdentifierTypeStateIssuer
7100050630MedicaidKY
2863558MedicaidOH

Other providers in Russell, KY

All providers in Russell, KY · Psychiatry Physician in Kentucky

Sources for this page

Verify at the official NPI Registry.