Healthcare Provider Details

I. General information

NPI: 1497469373
Provider Name (Legal Business Name): TIERRA POWELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6280 GRELOT RD
MOBILE AL
36609-3614
US

IV. Provider business mailing address

6280 GRELOT RD
MOBILE AL
36609-3614
US

V. Phone/Fax

Practice location:
  • Phone: 251-288-5606
  • Fax:
Mailing address:
  • Phone: 251-288-5606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF12220605
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: