Provider Demographics
NPI:1114588407
Name:POWERS, NICOLE YVETTE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:YVETTE
Last Name:POWERS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 THOMAS JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23923-3787
Mailing Address - Country:US
Mailing Address - Phone:434-542-5187
Mailing Address - Fax:
Practice Address - Street 1:410 THOMAS JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23923-3787
Practice Address - Country:US
Practice Address - Phone:434-542-5187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177773363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health