Provider Demographics
NPI:1902187834
Name:POWELL, QUINTRISA (CRNA)
Entity Type:Individual
Prefix:
First Name:QUINTRISA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:QUINTRISA
Other - Middle Name:
Other - Last Name:HARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 171181
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-1181
Mailing Address - Country:US
Mailing Address - Phone:901-682-2872
Mailing Address - Fax:
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5202
Practice Address - Country:US
Practice Address - Phone:901-682-2872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN134309367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered