Individual
FRED M POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
100 WILSON RD, BENTLEYVILLE, PA 15314-1028
(724) 239-2390
(724) 239-2393
Mailing address
1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
(724) 632-6312
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP016579
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014582
CAMP HILL MEDICARE
PA
05
—
1007288440027
—
PA
05
—
1007288440030
—
PA
05
—
1007288440104
—
PA
05
—
1007288440105
—
PA
01
—
391809
FQHC
PA
01
—
391812
FQHC
PA
01
—
391827
FQHC
PA
01
—
391902
FQHC
PA
Enumeration date
09/19/2016
Last updated
09/19/2016
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