Provider Demographics
NPI:1619696390
Name:POWELL, KELLI MILLER (FNP-C)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:MILLER
Last Name:POWELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 BELFIELD DR
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-1217
Mailing Address - Country:US
Mailing Address - Phone:434-348-4680
Mailing Address - Fax:434-336-1003
Practice Address - Street 1:511 BELFIELD DR
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1217
Practice Address - Country:US
Practice Address - Phone:434-348-4680
Practice Address - Fax:434-336-1003
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184948363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024184948OtherVA BON