Provider Demographics
NPI:1124538384
Name:POWELL, ALLY MAYE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ALLY
Middle Name:MAYE
Last Name:POWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:ALLY
Other - Middle Name:MAYE
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4473 KEELER DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-2563
Mailing Address - Country:US
Mailing Address - Phone:614-634-5674
Mailing Address - Fax:
Practice Address - Street 1:4473 KEELER DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2563
Practice Address - Country:US
Practice Address - Phone:614-634-5674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH269170163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse