Provider Demographics
NPI:1255871943
Name:POWELL, KERRI M (CPNP)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:M
Last Name:POWELL
Suffix:
Gender:
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3234 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-6116
Mailing Address - Country:US
Mailing Address - Phone:931-707-8700
Mailing Address - Fax:931-456-0802
Practice Address - Street 1:3234 MILLER AVE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-6116
Practice Address - Country:US
Practice Address - Phone:931-707-8700
Practice Address - Fax:931-456-0802
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22349363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ027075Medicaid