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NPI Code Detail

MEDICARE: EMILY POWELL P.A.

MEDICARE: EMILY POWELL P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant103157NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00724845OTHERNCRAILROAD MEDICARE PTAN - INDIVIDUAL
2232009OTHERNCMEDICARE PTAN - GROUP
3DF8926OTHERNCRAILROAD MEDICARE PTAN - GROUP

General Provider Information

NPI Number : 1366510216
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY POWELL P.A.
Provider Business Mailing Address
First Line : 300 MOORESVILLE RD
Second Line :
City : KANNAPOLIS
State : NC
Zip : 28081-0304
Country : US
Telephone Number : 704-920-1000
Fax Number : 704-934-4270
Provider Business Practice Location Address
First Line : 300 MOORESVILLE RD
Second Line :
City : KANNAPOLIS
State : NC
Zip : 28081-0304
Country : US
Telephone Number : 704-920-1310
Fax Number : 704-934-4270
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2006
Last Update Date : 04/11/2022

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1487780383 — MRS. LILLY RANDALL WILSON CFNP
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Directions to “ EMILY POWELL P.A.” Practice Location

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