Individual
MRS. DEMETRIC L POKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
7295 FOX TRACE CV, SOUTHAVEN, MS 38671-8734
(901) 240-3653
Mailing address
7295 FOX TRACE CV, SOUTHAVEN, MS 38671-8734
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
H24
—
TN
Enumeration date
11/12/2009
Last updated
11/17/2011
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