Poke, Demetric L
Poke, Demetric L is an sole proprietor health care provider with primary practice located at 7295 Fox Trace Cv , Southaven MS 38671-8734. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavioral Analyst, which is considered as her primary health care specialty. Poke, Demetric L can be contacted via phone (901) 240-3653.Contact Information
Primary practice address
7295 Fox Trace Cv
Southaven MS 38671-8734
Phone: (901) 240-3653
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Behavioral Analyst | 103K00000X |
Profile Details
| NPI number | 1972830875 |
|---|---|
| LBN Legal business name | Poke, Demetric L |
| Credentials | Master of Arts (MA) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 12th, 2009 |
| Last updated | Nov 17th, 2011 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1972830875 | NPPES |
| Tennessee | MEDICAID | H24 |
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