Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 16746 | WV |
N | 208600000X | Surgeon | 16746 | WV |
N | 208200000X | Surgeon | 31797 | TN |
N | 208600000X | Surgeon | 31797 | TN |
Y | 2086S0102X | Surgical Critical Care | 31797 | TN |
NPI | 1053407809 |
---|---|
Provider Name | Dr. Melissa A Powell |
First Address | Johnson City, TN 37604-6971 |
Second Address | Johnson City, TN 37604-6971 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 22/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053407809 | (05) | NC |
1053407809 | (05) | VA |
3004661000 | (05) | WV |
3709285 | (02) | TN |
G59584 | (02) | |
P00358617 | RAILROAD MEDICARE (01) | WV |
Q002848 | (05) | TN |