Provider Demographics
NPI:1497898597
Name:POWELL, WILLIAM INGRAM IV (FNP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:INGRAM
Last Name:POWELL
Suffix:IV
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1728 FORDHAM BLVD
Mailing Address - Street 2:151 RAMS PLAZA
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2397
Mailing Address - Country:US
Mailing Address - Phone:919-968-1985
Mailing Address - Fax:919-942-0038
Practice Address - Street 1:1728 FORDHAM BLVD
Practice Address - Street 2:151 RAMS PLAZA
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2397
Practice Address - Country:US
Practice Address - Phone:919-968-1985
Practice Address - Fax:919-942-0038
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79098363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMP011213OtherNC MEDICAL BOARD REGISTRA
NCS21171Medicare UPIN