Provider Demographics
NPI:1629712989
Name:POWELL, DOROTHY ESTELLE (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ESTELLE
Last Name:POWELL
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 FLOWERING BRANCH AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-6604
Mailing Address - Country:US
Mailing Address - Phone:843-605-2455
Mailing Address - Fax:
Practice Address - Street 1:1019 HIGHWAY 17 S STE 121
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3702
Practice Address - Country:US
Practice Address - Phone:184-360-5245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily