Provence, Dallas Jordan Davis

Provence, Dallas Jordan Davis is an sole proprietor health care provider with primary practice located at 6254 Poplar Ave , Memphis TN 38119-4713. She recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatopathology, which is considered as her primary health care specialty. Provence, Dallas Jordan Davis can be contacted via phone (901) 624-3333.

Contact Information

Primary practice address
6254 Poplar Ave Memphis TN 38119-4713
Phone: (901) 624-3333
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatopathology 207ND0900X 28973 Tennessee

Profile Details

NPI number 1619556230
LBN Legal business name Provence, Dallas Jordan Davis
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 2nd, 2021
Last updated Apr 2nd, 2021 - about 3 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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