Provider Demographics
NPI:1669193728
Name:POWELL, RYAN ALYCE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:RYAN
Middle Name:ALYCE
Last Name:POWELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 DEFENSE HWY STE 103
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2458
Practice Address - Country:US
Practice Address - Phone:410-721-5280
Practice Address - Fax:410-721-2243
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP1032332363LF0000X
MDR237575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily