Provider Demographics
NPI:1629201025
Name:POWELL, ERIKA MARIE LOU (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:MARIE LOU
Last Name:POWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2135
Mailing Address - Country:US
Mailing Address - Phone:304-425-2355
Mailing Address - Fax:
Practice Address - Street 1:216 NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2135
Practice Address - Country:US
Practice Address - Phone:304-425-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVIN PROCESS363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant