Healthcare Provider Details

I. General information

NPI: 1144704875
Provider Name (Legal Business Name): STACY POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 DAUPHIN ST FL 5
MOBILE AL
36608-1753
US

IV. Provider business mailing address

29653 ANCHOR CROSS BLVD
DAPHNE AL
36526-9594
US

V. Phone/Fax

Practice location:
  • Phone: 251-625-6896
  • Fax: 251-472-4461
Mailing address:
  • Phone: 251-625-6896
  • Fax: 251-625-6897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0027680
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-137420
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: