Individual
MRS. LISA DELORIS SLADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
605 STADIUM DR, HATTIESBURG, MS 39401-4156
(601) 450-0310
(601) 450-0321
Mailing address
PO BOX 1729, HATTIESBURG, MS 39403-1729
(601) 545-3700
(601) 450-2493
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R772518
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08700008
—
MS
01
—
1043492770
FIRST CHOICE OF MISSISSIPPI
MS
01
—
11838342
CAQH ID #
MS
01
—
1719640P01
CIGNA
MS
01
—
2888996
UNITED HEALTH CARE
MS
01
—
9989130
AETNA
MS
Enumeration date
11/16/2006
Last updated
01/09/2015
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