Healthcare Provider Details

I. General information

NPI: 1942456603
Provider Name (Legal Business Name): CAROL THARP POWELL APRN, ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 JACKSON ST
MONROE LA
71201-7407
US

IV. Provider business mailing address

513 WALNUT ST
MONROE LA
71201-6229
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-4541
  • Fax: 318-966-4543
Mailing address:
  • Phone: 318-323-2328
  • Fax: 318-323-2221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP05573
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: