=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114060589
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER D POWELL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 07/25/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1310 S 4TH ST
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71852-3007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-845-1413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 DUSTY LN
-----------------------------------------------------
City | NEWHOPE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71959-8082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-398-5447
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | PT91868
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------