Davenport, Nicole Bautista

Davenport, Nicole Bautista is an individual health care provider with primary practice located at 6560 Fannin St Ste 1842 , Houston TX 77030-2715. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Davenport, Nicole Bautista can be contacted via phone (713) 790-2089.

Contact Information

Primary practice address
6560 Fannin St Ste 1842 Houston TX 77030-2715
Phone: (713) 790-2089
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA07728 Texas
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA00000 Texas

Profile Details

NPI number 1023382009
LBN Legal business name Davenport, Nicole Bautista
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 8th, 2012
Last updated Mar 17th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023382009 NPPES
Texas MEDICAID 296297903

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