Provider Demographics
NPI:1790914091
Name:POWELL, TASHA RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:TASHA
Middle Name:RENEE
Last Name:POWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4100 LAKE OTIS PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5231
Mailing Address - Country:US
Mailing Address - Phone:907-563-4810
Mailing Address - Fax:907-563-4811
Practice Address - Street 1:4100 LAKE OTIS PKWY STE 320
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5231
Practice Address - Country:US
Practice Address - Phone:907-563-4810
Practice Address - Fax:907-563-4811
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012491042084N0400X
WAMD605529382084N0400X
AZ601902084N0400X
AK1088622084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology