Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mrs. Dallas Jordan Davis Provence, NP

Individual provider Dermatopathology Physician · NPI 1619556230

Mrs. Dallas Jordan Davis Provence, NP is a Nurse Practitioner in Memphis, Tennessee. Qualified in 2020, 6 years ago. Practices with Levy Dermatology, PC, a 15-clinician group and accepts Medicare assignment. Licensed in Tennessee.

Years since qualifying
6
Licensed in
TN
In the registry since
2021
What do these letters mean?
NP — Nurse Practitioner
An advanced practice nurse who can diagnose, treat and in most states prescribe.

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Practice location Address checks out

6254 Poplar Ave
Memphis, TN 38119-4713
Phone: (901) 624-3333
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatopathology Physician (primary) Taxonomy 207ND0900X · Licence 28973 (TN)

Record details

NPI number1619556230
Entity typeIndividual (Type 1)
GenderFemale
Credentials NP
Sole proprietorYes
NPI enumeratedApril 2, 2021
Last updated in NPPESApril 2, 2021
Certification dateMarch 14, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Levy Dermatology, Pc — 15 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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