Healthcare Provider Details

I. General information

NPI: 1639977135
Provider Name (Legal Business Name): PAIGE POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 BIENVILLE BLVD
OCEAN SPRINGS MS
39564-5711
US

IV. Provider business mailing address

16448 GRANDWAY BLVD
SAUCIER MS
39574-6010
US

V. Phone/Fax

Practice location:
  • Phone: 228-872-1951
  • Fax: 228-875-9998
Mailing address:
  • Phone: 228-861-4935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number907266
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number907266
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: