Provider Demographics
NPI:1215633631
Name:POWERS, MADISON SHIPLEY
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:SHIPLEY
Last Name:POWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6385 BRISTOL HWY APT 250
Mailing Address - Street 2:
Mailing Address - City:PINEY FLATS
Mailing Address - State:TN
Mailing Address - Zip Code:37686-5235
Mailing Address - Country:US
Mailing Address - Phone:423-483-4540
Mailing Address - Fax:
Practice Address - Street 1:6385 BRISTOL HWY APT 250
Practice Address - Street 2:
Practice Address - City:PINEY FLATS
Practice Address - State:TN
Practice Address - Zip Code:37686-5235
Practice Address - Country:US
Practice Address - Phone:423-483-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program