Provider Demographics
NPI:1679581052
Name:POWELL, EILEEN A (PMHNP)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:A
Last Name:POWELL
Suffix:
Gender:F
Credentials:PMHNP
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 BROAD AVE
Mailing Address - Street 2:GULF COAST MENTAL HEALTH CENTER
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-3603
Mailing Address - Country:US
Mailing Address - Phone:609-861-1834
Mailing Address - Fax:609-652-3573
Practice Address - Street 1:15120 COUNTY BARN RD
Practice Address - Street 2:GULF COAST MENTAL HEALTH CENTER CSU UNIT
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-1263
Practice Address - Country:US
Practice Address - Phone:609-748-4037
Practice Address - Fax:609-652-3573
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS891744363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q39286Medicare UPIN
089227Medicare ID - Type Unspecified