Healthcare Provider Details

I. General information

NPI: 1730095910
Provider Name (Legal Business Name): TIFFANY PRATCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 SWINNEA RDG STE 1
SOUTHAVEN MS
38671-6037
US

IV. Provider business mailing address

970 SWINNEA RDG STE 1
SOUTHAVEN MS
38671-6037
US

V. Phone/Fax

Practice location:
  • Phone: 901-677-3405
  • Fax: 901-441-8920
Mailing address:
  • Phone: 901-677-3405
  • Fax: 901-441-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM9589
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: