Provider Demographics
NPI:1710923503
Name:POWELL, JANA K (NP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:K
Last Name:POWELL
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:MEDPARTNERS, ATTN: MEGAN FORTNEY
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3515
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7916 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-432-2297
Practice Address - Fax:260-479-2950
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2017-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71000566A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200366330Medicaid
IN000000504551OtherANTHEM
INP00400736OtherMEDICARE - RAILROAD
S69989Medicare UPIN
IN200366330Medicaid
IN058490GGGGMedicare Oscar/Certification