BRADLEY PROVENCE
NPI 1225442155
Pharmacist - Nutrition Support in Millington, TN

Q: What is Bradley Provence's NPI number?

The NPI number for Bradley Provence is 1225442155. It was assigned to this individual provider in the NPPES registry on June 18, 2014.

Q: What is Bradley Provence's specialty?

The primary specialty registered for this NPI is Pharmacist, specializing in Nutrition Support, with taxonomy code 1835N1003X.

Q: When was this NPI record last updated?

The NPPES record for Bradley Provence was last updated on June 18, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 18, 2014

7899 C ST, MILLINGTON, TN 38053(901) 872-2214 Get Directions Write a Review

NPPES record last updated: June 18, 2014. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Bradley Provence NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BRADLEY PROVENCE (NPI 1225442155) is an individual nutrition support provider in Millington, Tennessee, licensed in Tennessee (7696) and active in the NPI registry since June 2014.

NPPES Registry Identity

NPI1225442155

Entity TypeIndividualMale

Primary Taxonomy1835N1003X

Provider Legal NameBRADLEY PROVENCE

Location Address7899 C STMillington, TN 38053-2137

Mailing Address7899 C StMillington, TN 38053-2137 · (901) 872-2214

Phone(901) 872-2214

Sole ProprietorYes

Enumeration DateJune 18, 2014

✔ NPI 1225442155 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacist · Nutrition SupportPharmacy Service Providers

Taxonomy Code1835N1003X

License✔ Licensed in TN · 7696

Definition

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.

7899 C ST, Millington, TN 38053

Open in Google Maps ↗

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DANIEL ROBERT JINKS PHARMD

Pharmacist

7899 C ST
MILLINGTON, TN 38053

Shelby County (901) 872-2214

STEVEN L BOATWRIGHT DPH

Pharmacist

7899 C ST
MILLINGTON, TN 38053

Shelby County (901) 872-2214

RONALD L ZUMSTEIN RPH

Pharmacist

7899 C ST
MILLINGTON, TN 38053

Shelby County (901) 872-2214

BOATWRIGHT DRUG CO., INC

Pharmacist

7899 C ST
MILLINGTON, TN 38053

Shelby County (901) 872-2214

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bradley Provence's NPI number?

The NPI number for Bradley Provence is 1225442155. It was assigned to this individual provider in the NPPES registry on June 18, 2014.

Where is Bradley Provence located?

Bradley Provence practices at 7899 C St, Millington, TN 38053. The listed phone number is (901) 872-2214.

What is Bradley Provence's specialty?

The primary specialty registered for this NPI is Pharmacist, specializing in Nutrition Support, with taxonomy code 1835N1003X.

When was this NPI record last updated?

The NPPES record for Bradley Provence was last updated on June 18, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.