Individual
MR. RICKY A POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
675 OLD BALLAS RD STE 100, SAINT LOUIS, MO 63141-7083
(314) 733-9009
Mailing address
675 OLD BALLAS RD STE 100, SAINT LOUIS, MO 63141-7083
(314) 733-9009
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
114408
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122134
BLUE CROSS BLUE SHIELD
MO
01
—
385496
HEALTHLINK
MO
01
—
7836224
AETNA
MO
Enumeration date
06/27/2006
Last updated
11/01/2021
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