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Contact Information

LISA D SLADE, FNP-BC
605 STADIUM DR
HATTIESBURG, MS39401-4156
 Phone: 601-450-0310
 Fax: 601-450-0321
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family

363LF0000X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for LISA D SLADE · (Female)

NPI Number 1013080027
Status Active
Credentials FNP-BC (Family Nurse Practitioner)
Entity Individual
Enumeration date 11/16/2006
Last updated 01/09/2015 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • MS License # R772518
  • MS Medicaid 08700008
  • MS Other 9989130 AETNA
  • MS Other 11838342 CAQH ID #
  • MS Other 1719640P01 CIGNA
  • MS Other 1043492770 FIRST CHOICE OF MISSISSIPPI
  • MS Other 2888996 UNITED HEALTH CARE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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