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Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

MRS. DALLAS JORDAN DAVIS PROVENCE, NP

Active Sole Proprietor

Dermatopathology · MEMPHIS, TN

Registration Details

NPI Number
1619556230
Provider Type
Individual
Gender
Female
NPI Issued
Apr 2, 2021 (5.0540207979312 yrs)
Last Updated
Apr 2, 2021
License
28973 (TN)
Sole Proprietor
Yes

Practice Information

Address
6254 POPLAR AVE
MEMPHIS, TN, 381194713
Browse TN providers · Browse ZIP 38119
Phone
9016243333
Primary Specialty
Dermatopathology
207ND0900X

Other Dermatopathology Providers in MEMPHIS, TN

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.