| Doctor Name: | MRS. LISA DELORIS SLADE |
| NPI Number: | 1013080027 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | R772518 |
| Business Practice Address: | 605 Stadium Dr Hattiesburg, MS - 394014156 |
| Business Phone Number: | 6014500310 |
| Business Fax Number: | 6014500321 |
| Mailing Address: | Po Box 1729, HATTIESBURG |
| State: | MS |
| Postal Code: | 394031729 |
| Phone Number: | 6015453700 |
| Fax Number: | 6014502493 |
| NPI Enumeration Date: | 11/16/2006 |
| NPI Last Update Date: | 01/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R772518 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |