Provider Demographics
NPI:1386626851
Name:POWE, NICOLE M (DNP, CNM, WHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:M
Last Name:POWE
Suffix:
Gender:F
Credentials:DNP, CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-3926
Mailing Address - Country:US
Mailing Address - Phone:601-482-1002
Mailing Address - Fax:601-482-1190
Practice Address - Street 1:1221 24TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3926
Practice Address - Country:US
Practice Address - Phone:601-482-1002
Practice Address - Fax:601-484-7561
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR846324363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL113013Medicaid
MS08508791Medicaid
AL113013Medicaid
420000042Medicare ID - Type Unspecified