Healthcare Provider Details

I. General information

NPI: 1598287245
Provider Name (Legal Business Name): JAMI DANIELLE POWELL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 CHESTER BLVD REID URGENT CARE
RICHMOND IN
47374-1914
US

IV. Provider business mailing address

1100 REID PKWY MEDICAL STAFF SVCS
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-935-1905
  • Fax: 765-935-1910
Mailing address:
  • Phone: 765-935-1905
  • Fax: 765-935-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71007336A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28173448A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: