Provider Demographics
NPI:1518856574
Name:DAVENPORT, PAMELA MARIE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARIE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ZYRA'KETH
Other - Middle Name:
Other - Last Name:DU VALLEROY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:511 N LINCOLN ST STE 444
Mailing Address - Street 2:
Mailing Address - City:HIGH SHOALS
Mailing Address - State:NC
Mailing Address - Zip Code:28077-9700
Mailing Address - Country:US
Mailing Address - Phone:484-213-2922
Mailing Address - Fax:704-240-3393
Practice Address - Street 1:121 W MAIN AVE # 302
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4154
Practice Address - Country:US
Practice Address - Phone:704-601-2646
Practice Address - Fax:704-601-2646
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth Educator