Provider Demographics
NPI:1194443788
Name:POWELL, DEEDDA RENAE (DNP-PMHNP)
Entity type:Individual
Prefix:DR
First Name:DEEDDA
Middle Name:RENAE
Last Name:POWELL
Suffix:
Gender:
Credentials:DNP-PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 E INDEPENDENCE BLVD STE 501
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-5494
Mailing Address - Country:US
Mailing Address - Phone:704-890-4309
Mailing Address - Fax:
Practice Address - Street 1:4801 E INDEPENDENCE BLVD STE 501
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-5494
Practice Address - Country:US
Practice Address - Phone:704-388-6736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPOWE-X2E45363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health