Provider Demographics
NPI:1558686402
Name:POWERS, REBECCA (APN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-347-3492
Practice Address - Street 1:2624 HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:AR
Practice Address - Zip Code:72324-8674
Practice Address - Country:US
Practice Address - Phone:870-442-2040
Practice Address - Fax:870-442-2042
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03349363LF0000X
ARATP-000260363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR185061758Medicaid
AR185061758Medicaid
AR57297Medicare PIN