| Lana J Davenport Md Plc | |
|
1451 Diederich Blvd Russell KY 41169-1718 | |
| (606) 547-4536 | |
| (866) 511-5587 |
| Full Name | Lana J Davenport Md Plc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 1451 Diederich Blvd, Russell, Kentucky |
| Authorized Official Name and Position | Lana J Davenport (OWNER) |
| Authorized Official Contact | 6065474536 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lana J Davenport Md Plc 1451 Diederich Blvd Russell KY 41169-1718 Ph: (606) 547-4536 | Lana J Davenport Md Plc 1451 Diederich Blvd Russell KY 41169-1718 Ph: (606) 547-4536 |
| NPI Number | 1992037337 |
|---|---|
| Provider Enumeration Date | 02/10/2010 |
| Last Update Date | 06/27/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992037337 | NPI | - | NPPES |
| 7100050630 | Medicaid | KY | |
| 2863558 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 42000 (Kentucky) | Primary |
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