Individual
REBECCA A POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1505 STATE HIGHWAY 19 S, ATHENS, TX 75751-8950
(903) 675-1725
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
509858
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
306295201
—
TX
05
—
306295202
—
TX
01
—
752616977029
TRICARE
TX
01
—
752616977043
TRICARE
TX
01
—
880N25
BCBS
TX
01
—
P02207511
MEDICARE RAIL ROAD
TX
Enumeration date
07/27/2012
Last updated
05/20/2019
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