Provider Demographics
NPI:1871360263
Name:DAVENPORT, KAYLA (CEO, PROVIDER, CNA)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:CEO, PROVIDER, CNA
Other - Prefix:PROF
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CEO, PROVIDER, CNA
Mailing Address - Street 1:5638 APGAR ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-2604
Mailing Address - Country:US
Mailing Address - Phone:832-640-6798
Mailing Address - Fax:281-446-0073
Practice Address - Street 1:5638 APGAR ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-2604
Practice Address - Country:US
Practice Address - Phone:832-845-1503
Practice Address - Fax:281-446-0073
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA08954281376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide