Provider Demographics
NPI:1063697688
Name:POWNALL, AMBRE' LACHELLE (APN, PNP-BC)
Entity type:Individual
Prefix:
First Name:AMBRE'
Middle Name:LACHELLE
Last Name:POWNALL
Suffix:
Gender:F
Credentials:APN, PNP-BC
Other - Prefix:
Other - First Name:AMBRE'
Other - Middle Name:LACHELLE
Other - Last Name:HUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, PNP-BC
Mailing Address - Street 1:1 CHILDRENS WAY # 653
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1100
Mailing Address - Fax:501-364-1522
Practice Address - Street 1:1 CHILDRENS WAY # 653
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-1100
Practice Address - Fax:501-364-1522
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR79537163WX0800X
ARA03311363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5V334Medicare PIN