Provider Demographics
NPI:1679231625
Name:POWERS, ADAM (CRNP)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:POWERS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-2309
Mailing Address - Country:US
Mailing Address - Phone:814-934-2685
Mailing Address - Fax:814-527-3137
Practice Address - Street 1:509 W 20TH ST
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-2309
Practice Address - Country:US
Practice Address - Phone:814-934-2685
Practice Address - Fax:814-527-3137
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024984363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily