Provider Demographics
NPI:1306519848
Name:POWERS, EBONE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:EBONE
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 FORT CAMPBELL BLVD UNIT 20026
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-2330
Mailing Address - Country:US
Mailing Address - Phone:931-378-8826
Mailing Address - Fax:
Practice Address - Street 1:1914 S VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-3610
Practice Address - Country:US
Practice Address - Phone:270-220-0366
Practice Address - Fax:270-220-0369
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN218632163W00000X
KY3016946363LF0000X
TN29552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse