Most Relevant Information
Provider Data
| NPI Number: | 1003476417 |
| Provider Name: | SARAH GEHRING PROVENCE MS, RD, LDN, CDCES |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: | D1643 |
Most Important Dates
| Enumeration Date: | 06/18/2019 |
| Last Updated: | 12/14/2023 |
Provider Practice Location
2150 DICKENS PLACE DR
SOUTHAVEN
MS
386727152
Practice Location Phone/Fax
| Phone: | 9013877314 |
| Fax: |
Provider Mailing Location
2150 DICKENS PLACE DR
SOUTHAVEN
MS
386727152
Provider Mailing Phone/Fax
| Phone: | 9013877314 |
| Fax: |