Provider Demographics
NPI:1992802987
Name:POWELL, CHRISTOPHER (PA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2031 AUDUBON AVE
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-5073
Mailing Address - Country:US
Mailing Address - Phone:985-803-8383
Mailing Address - Fax:985-227-9034
Practice Address - Street 1:1990 INDUSTRIAL BOULEVARD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70363-7055
Practice Address - Country:US
Practice Address - Phone:985-868-9300
Practice Address - Fax:985-851-0053
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10178RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1626741Medicaid
LA57627PC56Medicare PIN
LAR56836Medicare UPIN