LISSA KELLY BABER


Address: 1340 Broad Ave, Gulfport, MS 39501-2404
Phone: 2288675012

LISSA KELLY BABER (NPI# 1306409040) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1306409040
Entity Type Individual
Full Name LISSA KELLY BABER
Credential AGACNP
Practice Address 1340 Broad Ave
Gulfport
MS 39501-2404
Mailing Address 5 Oak Alley Ln
Long Beach
MS 39560-8000
Practice Telephone 2288675012
Mailing Telephone 6014330575
Enumeration Date 2019-04-18
Last Update Date 2019-06-30
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LA2100X Nurse Practitioner
Specialization: Acute Care
903259 MS Physician Assistants & Advanced Practice Nursing Providers

Provider Secondary Practice Location

Address Telephone Number Fax Number
4500 13th St, Gulfport, MS 395012569 2288674000

Office Location

Street Address 1340 BROAD AVE
City GULFPORT
State MS
Zip Code 39501-2404

Providers in the same location

NPI Name Taxonomy Address Enumeration
1912904590 Jesse Pullen Penico Internal Medicine 1340 Broad Ave, Suite 300, Gulfport, MS 39501-2404 2005-06-28
1780191577 Tbd Acquisition II LLC Social Worker 1340 Broad Ave, Gulfport, MS 39501-2404 2018-01-03
1629517115 Delana Mooney Nurse Practitioner 1340 Broad Ave, Suite 450, Gulfport, MS 39501-2404 2017-02-16
1396299590 Charles Strange Nurse Practitioner 1340 Broad Ave, Suite 450, Gulfport, MS 39501-2404 2016-08-05
1942699988 Beth Ann Gruzinskas Nurse Practitioner 1340 Broad Ave, Suite 270, Gulfport, MS 39501-2404 2015-01-14
1720477714 Lacey Grimes Lichtenstein Nurse Practitioner 1340 Broad Ave, Gulfport, MS 39501-2404 2015-01-14
1669872974 Jamie B Varnado Social Worker 1340 Broad Ave, Ste 410, Gulfport, MS 39501-2404 2014-08-25
1700121209 Danielle Ronquille Lipski Occupational Therapist 1340 Broad Ave, Suite 270, Gulfport, MS 39501-2404 2012-12-10
1164767778 Shannon Ann Church Social Worker 1340 Broad Ave, Ste 410, Gulfport, MS 39501-2404 2012-12-07
1649552563 Taylor E. Covington Physician Assistant 1340 Broad Ave, Suite 210, Gulfport, MS 39501-2404 2011-09-16
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1598301632 Daniel Edward Bloom Physician Assistant Naval Branch Health Clinic Gulfport, 5502 Marvin Shields Blvd, Gulfport, MS 39501 2019-11-25
1730721374 Affinity Healthcare LLC Non-emergency Medical Transport (VAN) 1822 15th St, Suite 8, Gulfport, MS 39501 2019-10-15
1093361156 Gulf Coast Companion Care, LLC Home Health 1314 Pass Road, Ste B, Gulfport, MS 39501 2019-08-14
1609420991 Greg Meekin Ent Otolaryngology 1201 31st Avenue, Gulfport, MS 39501 2019-07-25
1225681216 Murphy Chiropractic Gulfport, LLC Clinic/Center 2700 25th Ave., Gulfport, MS 39501 2019-07-19
1477022838 Patriot Healthcare of Mississippi, LLC Family Medicine 1110 Broad Street, Suite 300, Gulfport, MS 39501 2018-11-15
1477003028 Mindful Matters Nurse Practitioner 1613 23rd Avenue, Gulfport, MS 39501 2016-10-06
1902294093 Tangular Barnes Nurse Practitioner Gulf Coast Mental Health Center, 1600 Broad Ave, Gulfport, MS 39501 2014-12-25
1487065355 Huong Nguyen Pharmacist 2433 25th Avenue, Gulfport, MS 39501 2014-05-14
1770907412 Matthew Coleman Military Health Care Provider Nbhc Naval Construction Battalion Center Gulfport, 5501 Marvin Shields Blvd, Gulfport, MS 39501 2014-02-18
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Taxonomy Information

Taxonomy Code 363LA2100X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Acute Care

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1588212229 David Buckheister Nurse Practitioner 612 Liz Cir, Gulfport, MS 39503-3712 2019-08-27
1710209184 Amy Alyssa Simpson-waid Nurse Practitioner 11334 Peyton Dr, Gulfport, MS 39503 2010-02-25
1457543183 Diane C. Jakins Nurse Practitioner 400 Security Sq, Gulfport, MS 39507-1932 2007-08-16
1891289955 Brittany L Stewart Nurse Practitioner 4500 13th St, Gulfport, MS 39501-2515 2018-06-21
1023469244 Michelle Wright Taylor Nurse Practitioner 15190 Community Rd, Ste 220, Gulfport, MS 39503-3485 2016-06-29
1295107357 Tammy Vincent Nurse Practitioner 14116 Customs Blvd, Gulfport, MS 39503-5164 2015-10-28
1023417938 Carla Ann Rushing Nurse Practitioner 4500 13th St, Gulfport, MS 39501-2515 2014-08-15
1972910230 Elizabeth Drummond Nurse Practitioner 1391 Broad Ave, Gulfport, MS 39501-2419 2014-07-18
1932527264 Brandi Saksa Nurse Practitioner 4500 13th St, Gulfport, MS 39501-2515 2014-04-03
1346684925 Darlene Ann Petersen Nurse Practitioner 4500 13th St, Gulfport, MS 39501-2515 2013-04-25
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Competitor

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City GULFPORT
Zip Code 39501

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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