Provider Demographics
NPI:1861468407
Name:POWELL, JAN L (ARNP)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:L
Last Name:POWELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-0189
Mailing Address - Country:US
Mailing Address - Phone:502-268-5500
Mailing Address - Fax:502-268-3600
Practice Address - Street 1:10235 HIGHWAY 421 N
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:KY
Practice Address - Zip Code:40045-1541
Practice Address - Country:US
Practice Address - Phone:502-268-5500
Practice Address - Fax:502-268-3600
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3132P363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000315235OtherANTHEM
KY50003254OtherPASSPORT
KY2444695000OtherPASSPORT ADVANTAGE
KY78006392Medicaid
KY78006392Medicaid