Provider Demographics
NPI:1982426391
Name:POWELL, KATIE NICOLE (FNP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:NICOLE
Last Name:POWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 E WEIDMAN RD
Mailing Address - Street 2:
Mailing Address - City:ROSEBUSH
Mailing Address - State:MI
Mailing Address - Zip Code:48878-9710
Mailing Address - Country:US
Mailing Address - Phone:989-506-5170
Mailing Address - Fax:
Practice Address - Street 1:238 S CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:SHEPHERD
Practice Address - State:MI
Practice Address - Zip Code:48883-9078
Practice Address - Country:US
Practice Address - Phone:989-773-5921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704369222363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily