Provider Demographics
NPI:1366890253
Name:POWELL, TRINA DARLENE (PA)
Entity type:Individual
Prefix:MS
First Name:TRINA
Middle Name:DARLENE
Last Name:POWELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3713 UNIVERSITY DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6202
Mailing Address - Country:US
Mailing Address - Phone:919-401-6212
Mailing Address - Fax:919-401-4170
Practice Address - Street 1:3713 UNIVERSITY DR
Practice Address - Street 2:SUITE B
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6202
Practice Address - Country:US
Practice Address - Phone:919-401-6212
Practice Address - Fax:919-401-4170
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06450364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health