Basic Information
| Provider Information | |||||||||
| NPI: | 1386626851 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWE | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, CNM, WHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 24TH AVE | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393013926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014821002 | ||||||||
| FaxNumber: | 6014821190 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 24TH AVE | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393013926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014821002 | ||||||||
| FaxNumber: | 6014847561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 08/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | R846324 | MS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 367A00000X | R846324 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 113013 | 05 | AL | MEDICAID | 08508791 | 05 | MS | MEDICAID |