Provider Demographics
NPI:1992354310
Name:PROCTOR, POWELL RUSS (FNP)
Entity type:Individual
Prefix:MR
First Name:POWELL
Middle Name:RUSS
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:695 W FLEMING DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4450
Mailing Address - Country:US
Mailing Address - Phone:828-580-3278
Mailing Address - Fax:828-580-3279
Practice Address - Street 1:695 W FLEMING DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4450
Practice Address - Country:US
Practice Address - Phone:828-580-3278
Practice Address - Fax:828-580-3279
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012226363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily