Provider Demographics
NPI:1336392679
Name:POWELL, WAYNE MILLER III (APRN, FPMHNP)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:MILLER
Last Name:POWELL
Suffix:III
Gender:M
Credentials:APRN, FPMHNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:823 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOPE VALLEY
Mailing Address - State:RI
Mailing Address - Zip Code:02832-1920
Mailing Address - Country:US
Mailing Address - Phone:401-539-2461
Mailing Address - Fax:802-747-0129
Practice Address - Street 1:823 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPE VALLEY
Practice Address - State:RI
Practice Address - Zip Code:02832-1920
Practice Address - Country:US
Practice Address - Phone:401-539-2461
Practice Address - Fax:401-539-2490
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010021563363LP0808X
RIAPRN01892363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health