Provider Demographics
NPI:1568219863
Name:DUSTIN POWERS PRACTITIONERS LLC
Entity type:Organization
Organization Name:DUSTIN POWERS PRACTITIONERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:540-204-3030
Mailing Address - Street 1:6110 WISTERIA PLACE CT
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-8830
Mailing Address - Country:US
Mailing Address - Phone:540-204-3030
Mailing Address - Fax:
Practice Address - Street 1:2081 LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1443
Practice Address - Country:US
Practice Address - Phone:434-846-8437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-03
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily