Individual
MS. HEATHER LEIGH PRIDGEN POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11637 TERRACE DR STE 100, WALDORF, MD 20602-3707
(301) 870-7287
(301) 870-0687
Mailing address
11637 TERRACE DR STE 100, WALDORF, MD 20602-3707
(301) 870-7287
(904) 493-3395
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
C06485
MD
363A00000X
Physician Assistant
Primary
PA9113940
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y0PK3
FLORIDA BLUE
FL
Enumeration date
09/22/2014
Last updated
04/06/2021
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