Provider Demographics
NPI:1811296254
Name:POWERS, JENIFER NICOLE (MD)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:NICOLE
Last Name:POWERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:
Other - Last Name:JARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2231 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2254
Mailing Address - Country:US
Mailing Address - Phone:702-383-2663
Mailing Address - Fax:
Practice Address - Street 1:2231 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2254
Practice Address - Country:US
Practice Address - Phone:702-383-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV22622207X00000X, 207XP3100X
390200000X
TXR0933207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program