Healthcare Provider Details

I. General information

NPI: 1891658928
Provider Name (Legal Business Name): DENITRA DAVIS M.ED., MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 RIDGE MEADOW PKWY STE 105
MEMPHIS TN
38115-4041
US

IV. Provider business mailing address

35 CROSS POINTE DR
JACKSON TN
38305-7595
US

V. Phone/Fax

Practice location:
  • Phone: 901-859-3736
  • Fax:
Mailing address:
  • Phone: 901-859-3736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: