Provider Demographics
NPI:1699927962
Name:POWELL, ANATHEA CARLSON (MD)
Entity type:Individual
Prefix:DR
First Name:ANATHEA
Middle Name:CARLSON
Last Name:POWELL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1155 MILL ST # M14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-6270
Mailing Address - Fax:775-982-6271
Practice Address - Street 1:75 PRINGLE WAY STE 900
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-982-6270
Practice Address - Fax:775-982-6271
Is Sole Proprietor?:No
Enumeration Date:2008-10-18
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239021-1208600000X
AZ56046208C00000X
NV27036208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ720581Medicaid
NV13584556OtherCAQH NUMBER
NV27036OtherNV MD LIC