Individual
KELLI P. DAVENPORT
Active
Individual
KELLI P. DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LDN
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
L003889
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
169GG
BCBSNC
NC
Enumeration date
02/24/2012
Last updated
04/12/2012
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