Provider Demographics
NPI:1447607155
Name:POWELL, KARVAN
Entity type:Individual
Prefix:
First Name:KARVAN
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PROVIDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:71254-5208
Mailing Address - Country:US
Mailing Address - Phone:318-559-0551
Mailing Address - Fax:318-559-0551
Practice Address - Street 1:1700 LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE PROVIDENCE
Practice Address - State:LA
Practice Address - Zip Code:71254-5208
Practice Address - Country:US
Practice Address - Phone:318-559-0551
Practice Address - Fax:318-559-0538
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1316187321Other1316187321