Provider Demographics
NPI:1073257630
Name:POWERS, KARLIE RYAN (PA-C)
Entity Type:Individual
Prefix:
First Name:KARLIE
Middle Name:RYAN
Last Name:POWERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MISTLETOE CT APT C
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-4379
Mailing Address - Country:US
Mailing Address - Phone:954-621-7063
Mailing Address - Fax:
Practice Address - Street 1:515 MISTLETOE CT APT C
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-4379
Practice Address - Country:US
Practice Address - Phone:954-621-7063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant