Provider Demographics
NPI:1376814202
Name:POWELL, MELIKA KATHLEEN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MELIKA
Middle Name:KATHLEEN
Last Name:POWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 DAWNWOOD
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0302
Mailing Address - Country:US
Mailing Address - Phone:978-886-2532
Mailing Address - Fax:
Practice Address - Street 1:27522 ANTONIO PKWY STE P3
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2166
Practice Address - Country:US
Practice Address - Phone:949-267-3141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1024427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily