Provider Demographics
NPI:1821585761
Name:POWELL, KRISTEN MAJURE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MAJURE
Last Name:POWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MAJURE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7640 HWY 70 S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-1758
Mailing Address - Country:US
Mailing Address - Phone:615-352-2990
Mailing Address - Fax:615-352-5071
Practice Address - Street 1:7640 HWY 70 S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-1758
Practice Address - Country:US
Practice Address - Phone:615-352-2990
Practice Address - Fax:615-352-5071
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN63093208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ041532Medicaid