Provider Demographics
NPI:1013149939
Name:POWELL, TRACI A (NP)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:A
Last Name:POWELL
Suffix:
Gender:F
Credentials:NP
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 188
Mailing Address - Street 2:1049 WESTERN AVENUE
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-0188
Mailing Address - Country:US
Mailing Address - Phone:740-773-4366
Mailing Address - Fax:740-775-7855
Practice Address - Street 1:4439 STATE ROUTE 159 STE 150
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-7833
Practice Address - Country:US
Practice Address - Phone:740-779-8728
Practice Address - Fax:740-775-7855
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH312729363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3016042Medicaid
OH3016042Medicaid
OHNP31451Medicare PIN