Provider Demographics
NPI:1477885945
Name:POWELL, MICHELLE L
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:L
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7827 TOWN SQUARE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-6704
Mailing Address - Country:US
Mailing Address - Phone:636-734-0386
Mailing Address - Fax:636-561-7159
Practice Address - Street 1:7827 TOWN SQUARE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-6704
Practice Address - Country:US
Practice Address - Phone:636-734-0386
Practice Address - Fax:636-561-7159
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical