Healthcare Provider Details

I. General information

NPI: 1659880516
Provider Name (Legal Business Name): JENNIFER WINN POWELL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2017
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4692 BROWNSBORO RD
WINSTON SALEM NC
27106
US

IV. Provider business mailing address

4692 BROWNSBORO RD
WINSTON SALEM NC
27106-3410
US

V. Phone/Fax

Practice location:
  • Phone: 336-251-1114
  • Fax: 336-251-1117
Mailing address:
  • Phone: 336-251-1114
  • Fax: 336-251-1117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number220184
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22648
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5011676
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: