Individual
MRS. DIOSAN M POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
346 STATELINE RD W, SOUTHAVEN, MS 38671-1610
(662) 510-5353
(662) 510-0409
Mailing address
346 STATELINE RD W, SOUTHAVEN, MS 38671-1610
(662) 510-5353
(662) 404-8861
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
21474
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08778361
—
MS
Enumeration date
07/29/2016
Last updated
04/16/2026
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