Provider Demographics
NPI:1750053088
Name:POWELL, ALEXIA KRISTIANNA VASQUEZ (CRNP)
Entity type:Individual
Prefix:MRS
First Name:ALEXIA
Middle Name:KRISTIANNA VASQUEZ
Last Name:POWELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 E COUNTY RD 19
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360
Mailing Address - Country:US
Mailing Address - Phone:334-796-9867
Mailing Address - Fax:
Practice Address - Street 1:1118 ROSS CLARK CIR STE 302
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3049
Practice Address - Country:US
Practice Address - Phone:334-699-0060
Practice Address - Fax:334-699-0061
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-150624363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner