Provider Demographics
NPI:1043772932
Name:POWERS, CONNESUALA (APRN)
Entity Type:Individual
Prefix:
First Name:CONNESUALA
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 WINWOOD DR STE 205
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-1399
Mailing Address - Country:US
Mailing Address - Phone:615-444-4126
Mailing Address - Fax:855-785-2890
Practice Address - Street 1:115 WINWOOD DR STE 205
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1399
Practice Address - Country:US
Practice Address - Phone:615-444-4126
Practice Address - Fax:855-785-2890
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25546363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health