Individual
CHARLOTTE S POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
3531 EAST LAKELAND DRIVE, BRENTWOOD BEHAVIORAL HEALTHCARE OF MS, JACKSON, MS 39232-8839
(601) 936-2024
Mailing address
932 EUCLID AVE, JACKSON, MS 39202-1110
(601) 573-5922
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R545171
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00014892
—
MS
Enumeration date
06/16/2006
Last updated
10/01/2013
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