Healthcare Provider Details

I. General information

NPI: 1508792557
Provider Name (Legal Business Name): AMANDA MARIE POWELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BIRCH ST
RAEFORD NC
28376-3297
US

IV. Provider business mailing address

300 BIRCH ST
RAEFORD NC
28376-3297
US

V. Phone/Fax

Practice location:
  • Phone: 910-929-6944
  • Fax: 910-248-6864
Mailing address:
  • Phone: 910-929-6944
  • Fax: 910-248-6864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5024701
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: