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General NPI Number Information
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NPI Number | 1730812280
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Entity Type | Individual
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Provider Name | SHANIQUE POWELL FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 5514 LONE STAR PKWY STE 103
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City | SAN ANTONIO
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State | TX
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Zip | 78253-6770
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Country | US
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Telephone | 830-955-8515
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Fax | 210-688-9429
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Provider Business Mailing Address
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Address Line | 5514 LONE STAR PKWY STE 103
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City | SAN ANTONIO
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State | TX
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Zip | 78253-6770
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Country | US
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Telephone | 830-955-8515
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1069027
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License Number State | TX
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