Healthcare Provider Details

I. General information

NPI: 1063334506
Provider Name (Legal Business Name): TIFFANY JENA POWELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FLOWERS PRIDGEN DR
WHITEVILLE NC
28472-9110
US

IV. Provider business mailing address

200 FLOWERS PRIDGEN DR
WHITEVILLE NC
28472-9110
US

V. Phone/Fax

Practice location:
  • Phone: 910-642-4300
  • Fax:
Mailing address:
  • Phone: 910-642-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07261264
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: