Provider Demographics
NPI:1982019097
Name:POWELL, JAYCE (NPC)
Entity Type:Individual
Prefix:
First Name:JAYCE
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 JOURNAL CENTER BLVD NE
Mailing Address - Street 2:2ND FLOOR HAND CLINIC
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5900
Mailing Address - Country:US
Mailing Address - Phone:505-262-7375
Mailing Address - Fax:
Practice Address - Street 1:5150 JOURNAL CENTER BLVD NE
Practice Address - Street 2:2ND FLOOR HAND CLINIC
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5900
Practice Address - Country:US
Practice Address - Phone:505-262-7375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily