Healthcare Provider Details

I. General information

NPI: 1124231436
Provider Name (Legal Business Name): NANCY POWERS PSY D PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 5TH ST
RAPID CITY SD
57701-7316
US

IV. Provider business mailing address

2905 5TH ST
RAPID CITY SD
57701-7316
US

V. Phone/Fax

Practice location:
  • Phone: 605-341-8888
  • Fax: 605-341-0100
Mailing address:
  • Phone: 605-341-8888
  • Fax: 605-341-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number369
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1148
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number369
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1148
License Number StateCO

VIII. Authorized Official

Name: NANCY POWERS
Title or Position: PHYSICIAN
Credential:
Phone: 605-341-8888