Provider Demographics
NPI:1275054157
Name:POWELL, BEVERLY (APRN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:POWELL
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:SC HOUSE CALLS INC.
Mailing Address - Street 2:111 DOCTORS CIR.
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:800-491-0909
Mailing Address - Fax:866-527-0937
Practice Address - Street 1:SC HOUSE CALLS INC.
Practice Address - Street 2:111 DOCTORS CIR.
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:866-527-0937
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA181336363L00000X
FL11015114363LA2200X
SC23590RX363LA2200X
NYF310059-01363LA2200X
SC23590363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health