Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
BRADLEY PROVENCE
Active Sole ProprietorBRADLEY PROVENCE is a Nutrition Support Pharmacist healthcare provider located in MILLINGTON, Tennessee. NPI 1225442155 is currently active in the NPPES registry. Verify at CMS.
Nutrition Support Pharmacist · MILLINGTON, TN
Registration Details
- NPI Number
- 1225442155
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jun 18, 2014 (12.178290090649 yrs)
- Last Updated
- Jun 18, 2014
- License
-
7696 (TN)
- Sole Proprietor
- Yes
Practice Information
- Address
-
7899 C STMILLINGTON, TN, 380532137Browse TN providers · Browse ZIP 38053
- Phone
- 9018722214
- Primary Specialty
-
Nutrition Support Pharmacist
1835N1003X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.