Provider Demographics
NPI:1518592096
Name:POWELL, PATRICIA ANTOINETTE
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANTOINETTE
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 CAROLYN SUE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-5509
Mailing Address - Country:US
Mailing Address - Phone:225-928-9490
Mailing Address - Fax:225-924-9490
Practice Address - Street 1:1945 CAROLYN SUE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-5509
Practice Address - Country:US
Practice Address - Phone:225-928-9490
Practice Address - Fax:225-924-9490
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator