Provider Demographics
NPI:1285646059
Name:POWERS, NANCY (PSYD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7316
Mailing Address - Country:US
Mailing Address - Phone:605-341-8888
Mailing Address - Fax:605-341-0100
Practice Address - Street 1:2905 5TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7316
Practice Address - Country:US
Practice Address - Phone:605-341-8888
Practice Address - Fax:605-341-0100
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1148103TC0700X, 103G00000X
SD369103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC86166Medicare PIN
SDS101866Medicare PIN
COR20235Medicare UPIN