MEDICARE: SHAWNTAVIA POWE

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	363LF0000X	Family Nurse Practitioner	1-143824	AL
2	363LF0000X	Family Nurse Practitioner	NP500014926	DC
3	363LF0000X	Family Nurse Practitioner	TPAN1615	FL

General Provider Information

NPI Number	:	1861968760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNTAVIA POWE

Provider Business Mailing Address
First Line	:	120 19TH ST N APT 321
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-3256
Country	:	US
Telephone Number	:	205-498-5519
Fax Number	:	855-710-8104

Provider Business Practice Location Address
First Line	:	324 COMMONS DR STE 21
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-6962
Country	:	US
Telephone Number	:	205-498-5519
Fax Number	:	855-710-8104

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

Provider Enumeration Date	:	10/17/2018
Last Update Date	:	04/17/2026

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Directions to “ SHAWNTAVIA POWE ” Practice Location

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