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Contact Information

SARAH G PROVENCE, MS, RD, LDN, CDCES
2150 DICKENS PLACE DR
SOUTHAVEN, MS38672-7152
 Phone: 901-387-7314
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dietitian, Registered

133V00000X 71 Registered Dietitian or Nutrition Professional
 

Nutrition, Pediatric

133VN1004X 71 Registered Dietitian or Nutrition Professional
Indicates primary specialty

NPI Profile & details for SARAH G PROVENCE · (Female)

NPI # 1003476417
Status Active
Credentials MS, RD, LDN, CDCES
Entity Individual
Enumeration date 06/18/2019
Last updated 12/14/2023 - About 2 years ago
Sole proprietor 1 No
Identifiers
  • MS License # D1643
  • TN License # 2733
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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