Provider Demographics
NPI:1760105589
Name:POWERS, TANYA LYNETTE (AGNP-BC)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:LYNETTE
Last Name:POWERS
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 GROSSCUP AVE
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-3120
Mailing Address - Country:US
Mailing Address - Phone:304-768-8811
Mailing Address - Fax:
Practice Address - Street 1:1100 GROSSCUP AVE
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-3120
Practice Address - Country:US
Practice Address - Phone:304-768-8811
Practice Address - Fax:304-768-4072
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV114490363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology