# DAVENPORT ADULT AND GERIATRIC WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639799588
- **Authorized official:** NATHAN J DAVENPORT NP (PRESIDENT)
- **Authorized official phone:** (804) 564-6283

## Contact information

- **Practice address:** 6701 COURTYARD RD, CHESTER, VA 23831-1430
- **Practice address phone:** (804) 564-6283
- **Mailing address:** 9536 ASHLEYVILLE TURN, MIDLOTHIAN, VA 23112-1690
- **Mailing address phone:** (804) 564-6283

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/21/2020
- **Last updated:** 04/21/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0024169750 | VIRGINIA STATE MEDICAL LICENSE | VA |