Provider Demographics
NPI:1619431780
Name:POWELL, LISA DAWN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:POWELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:POWELL
Other - Last Name:LAFARLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11870 CRANSTON DR STE 104
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11870 CRANSTON DR STE 104
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-4913
Practice Address - Country:US
Practice Address - Phone:870-559-4252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26261207Q00000X, 363LF0000X
ARA006180363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty