Provider Demographics
NPI:1477924355
Name:POWERS, DEVON (AGPCNP)
Entity Type:Individual
Prefix:MISS
First Name:DEVON
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 SCAMRIDGE CURV
Mailing Address - Street 2:APT D1
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5237
Mailing Address - Country:US
Mailing Address - Phone:716-908-7674
Mailing Address - Fax:
Practice Address - Street 1:3 SILENT MEADOW LN
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-3430
Practice Address - Country:US
Practice Address - Phone:716-574-0476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-17
Last Update Date:2015-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9102604363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner