Provider Demographics
NPI:1104933134
Name:POWELL, RENEA L (RN,MSN,NNP)
Entity type:Individual
Prefix:MRS
First Name:RENEA
Middle Name:L
Last Name:POWELL
Suffix:
Gender:F
Credentials:RN,MSN,NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-7201
Mailing Address - Country:US
Mailing Address - Phone:214-456-2331
Mailing Address - Fax:
Practice Address - Street 1:4311 WESLEY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5639
Practice Address - Country:US
Practice Address - Phone:903-455-5958
Practice Address - Fax:903-455-1604
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX687079363LN0000X
TXAP115027363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179237604Medicaid