Provider Demographics
NPI:1104824382
Name:POWELL, ROBERT (CNP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 W ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-1906
Mailing Address - Country:US
Mailing Address - Phone:434-447-6969
Mailing Address - Fax:434-447-2240
Practice Address - Street 1:514 W ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-1906
Practice Address - Country:US
Practice Address - Phone:434-447-6969
Practice Address - Fax:434-447-2240
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010125685OtherVA PREMIER SOUTH HILL
VA21524OtherCARENET SH
VA010252393OtherVA PREMIER KENB
VA010252423Medicaid
VA21989OtherCARENET KB
VA60109OtherCARENET CC
VAP00215680OtherSH RR MEDICARE
VA010125685Medicaid
VA010252393Medicaid
224189800OtherDOL
VA009845C15Medicare PIN
VA21989OtherCARENET KB
VAP00215680OtherSH RR MEDICARE
VA010252423Medicaid
VA493833Medicare Oscar/Certification
VA21524OtherCARENET SH
VA009864K59Medicare PIN