Provider Demographics
NPI:1205581543
Name:POWERS, TIMOTHY LANDON (EMT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LANDON
Last Name:POWERS
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NEALCREST CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2689
Mailing Address - Country:US
Mailing Address - Phone:931-398-8396
Mailing Address - Fax:
Practice Address - Street 1:1000 NEALCREST CIR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2689
Practice Address - Country:US
Practice Address - Phone:931-398-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0366-5388-8272146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0366-5388-8272OtherNREMT
TNE3655162OtherNREMT