Individual
SARAH GEHRING PROVENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LDN, CDCES
Contact information
Practice address
2150 DICKENS PLACE DR, SOUTHAVEN, MS 38672-7152
(901) 387-7314
Mailing address
2150 DICKENS PLACE DR, SOUTHAVEN, MS 38672-7152
(901) 387-7314
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D1643
MS
133VN1004X
Pediatric Nutrition Registered Dietitian
2733
TN
Other
Enumeration date
06/18/2019
Last updated
12/14/2023
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