Provider Demographics
NPI:1326049354
Name:POWELL, NANCY M (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:M
Last Name:POWELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:POWDERLY
Mailing Address - State:KY
Mailing Address - Zip Code:42367-5463
Mailing Address - Country:US
Mailing Address - Phone:270-377-1631
Mailing Address - Fax:270-377-1683
Practice Address - Street 1:1010 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:POWDERLY
Practice Address - State:KY
Practice Address - Zip Code:42367-5463
Practice Address - Country:US
Practice Address - Phone:270-377-1631
Practice Address - Fax:270-377-1683
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2664P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78026648Medicaid
KY0625408Medicare PIN
KY78026648Medicaid