Healthcare Provider Details

I. General information

NPI: 1437279510
Provider Name (Legal Business Name): RICHARD ANTHONY MICHAEL POWELL APH,NMD,CAC,PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 SHOUP AVE W STE 14
TWIN FALLS ID
83301-4615
US

IV. Provider business mailing address

676 SHOUP AVE W STE 14
TWIN FALLS ID
83301-4615
US

V. Phone/Fax

Practice location:
  • Phone: 208-392-1829
  • Fax: 888-915-0796
Mailing address:
  • Phone: 208-392-1829
  • Fax: 888-915-0796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACC195
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: