BRADLEY PROVENCE (NPI# 1225442155) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225442155 |
| Entity Type | Individual |
| Full Name | BRADLEY PROVENCE |
| Practice Address |
7899 C St Millington TN 38053-2137 |
| Practice Telephone | 9018722214 |
| Mailing Telephone | 9018722214 |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2014-06-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1835N1003X |
Pharmacist Specialization: Nutrition Support |
7696 | TN | Pharmacy Service Providers |
| Street Address |
7899 C ST |
| City | MILLINGTON |
| State | TN |
| Zip Code | 38053-2137 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831280742 | Boatwright Drug Co., Inc | Pharmacist | 7899 C St, Millington, TN 38053-2137 | 2006-09-27 |
| 1578916284 | Daniel Robert Jinks | Pharmacist | 7899 C St, Millington, TN 38053-2137 | 2016-07-18 |
| 1801193925 | Ronald L Zumstein | Pharmacist | 7899 C St, Millington, TN 38053-2137 | 2011-02-25 |
| 1750556726 | Walter W Adams I | Pharmacist | 7899 C St, Millington, TN 38053-2137 | 2008-04-29 |
| 1720253701 | Steven L Boatwright | Pharmacist | 7899 C St, Millington, TN 38053-2137 | 2008-04-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124676325 | Marde M Walker | Nurse Practitioner | 8225 Highway 51 North, Millington, TN 38053 | 2019-08-30 |
| 1801457676 | Cale Porter Alexander | Physical Therapist | 8586 Highway 51 North, Millington, TN 38053 | 2019-06-24 |
| 1477957660 | Community Chiropractic | Chiropractor | 8110 Hwy 51 North, Suite 2, Millington, TN 38053 | 2014-10-16 |
| 1861739344 | Lydia A Sharpe | Pharmacist | 8039 Highway 51 North, Millington, TN 38053 | 2013-01-03 |
| 1063666261 | Phylliss Lamora Flowers | Nurse Practitioner | 7889 Astoria Rd, Millington, TN 38053 | 2008-11-14 |
| 1649447871 | William David Algea | Pediatrics | 8081 Highway 51 North, Millington, TN 38053 | 2008-05-15 |
| 1306051248 | Leader Physical Therapy Limited Partnership | Durable Medical Equipment & Medical Supplies | 8253 Highway 51 North, Suite 102, Millington, TN 38053 | 2007-05-14 |
| 1750406658 | Tammy E. Keough | Nurse Practitioner | 7889 Astoria, Millington, TN 38053 | 2007-03-20 |
| 1760516017 | West Tennessee Eye, Plc | Optometrist | 8120 Hwy 51n, Ste 7, Millington, TN 38053 | 2007-03-16 |
| 1932258787 | Mid South Wellness Center, Inc | Family Medicine | 7662 Highway 51north, Suite 2, Millington, TN 38053 | 2007-01-10 |
| Find all providers in zip 38053 | ||||
| Taxonomy Code | 1835N1003X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Nutrition Support |
| A licensed pharmacist who has demonstrated specialized knowledge and skill in maintenance and/or restoration of optimal nutritional status, designing and modifying treatment according to patient needs. |
| Notes: Source: Specialty certification and recertification program administered by Board of Pharmaceutical Specialties, www.bpsweb.org [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427170232 | Henry Larkin Wright | Pharmacist | 5214 Village Crest Way, Apt. 125, Knoxville, TN 37924-5005 | 2007-04-04 |
| 1285255687 | Shannon Slate | Pharmacist | 217 W Maplewood Ln, Nashville, TN 37207-2981 | 2020-04-27 |
| 1407317563 | Andrea Mcnalley Gerwin | Pharmacist | 975 E 3rd St, Chattanooga, TN 37403-2147 | 2019-03-29 |
| 1821008608 | Kevin Lee Freeman | Pharmacist | 1030 Jefferson Ave, Memphis, TN 38104-2127 | 2006-08-08 |
| City | MILLINGTON |
| Zip Code | 38053 |
Please comment or provide details below to improve the information on BRADLEY PROVENCE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.