MEDICARE: MRS. MELISSA ANN POWELL FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024177526	VA

General Provider Information

NPI Number	:	1790349405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA ANN POWELL FNP

Provider Business Mailing Address
First Line	:	501 E WATAUGA AVE
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-4038
Country	:	US
Telephone Number	:	423-722-8446
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 E WATAUGA AVE
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-4038
Country	:	US
Telephone Number	:	423-722-8446
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2019
Last Update Date	:	02/25/2026

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