Healthcare Provider Details

I. General information

NPI: 1144004904
Provider Name (Legal Business Name): CASEY FORREST POWELL DNP, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 03/29/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1173 S 250 W STE 503
ST GEORGE UT
84770-7190
US

IV. Provider business mailing address

2403 E 80 NORTH CIR
ST GEORGE UT
84790-5468
US

V. Phone/Fax

Practice location:
  • Phone: 435-674-0217
  • Fax:
Mailing address:
  • Phone: 503-209-6799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12050251-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number73527
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: