MEDICARE: SHNARIKA SIMONE POWELL NURSE PRACTITIONER

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN244465	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP61540188	OTHER	WA	LICENSE

General Provider Information

NPI Number	:	1720786858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHNARIKA SIMONE POWELL NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	9723 109TH STREET CT SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98498-3059
Country	:	US
Telephone Number	:	404-388-2333
Fax Number	:

Provider Business Practice Location Address
First Line	:	9723 109TH STREET CT SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98498-3059
Country	:	US
Telephone Number	:	404-388-2333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2023
Last Update Date	:	01/17/2026

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