Provider Demographics
NPI:1013712553
Name:POWELL, LISA VICTORIA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:VICTORIA
Last Name:POWELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CHABLIS LN
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2221
Mailing Address - Country:US
Mailing Address - Phone:504-616-4400
Mailing Address - Fax:
Practice Address - Street 1:401 CHABLIS LN
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2221
Practice Address - Country:US
Practice Address - Phone:504-616-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program