Provider Demographics
NPI:1477572972
Name:POWELL, JANET W (NP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:W
Last Name:POWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:W
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2050 MEADOWVIEW PARKWAY
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660
Mailing Address - Country:US
Mailing Address - Phone:423-230-5000
Mailing Address - Fax:423-230-5010
Practice Address - Street 1:329 COATSLAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3912
Practice Address - Country:US
Practice Address - Phone:731-425-5080
Practice Address - Fax:731-660-8739
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5754363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3909427Medicaid
TNP01221178OtherRR MEDICARE
TN10350I1735Medicare PIN
TN103I507948Medicare PIN
3909427Medicare Oscar/Certification
TN3909427Medicare ID - Type UnspecifiedCIGNA
VA8948364Medicaid