Basic Information
| Provider Information | |||||||||
| NPI: | 1497898597 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | INGRAM | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | IV | ||||||||
| Credential: | F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1728 FORDHAM BLVD | ||||||||
| Address2: | 151 RAMS PLAZA | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275142397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199681985 | ||||||||
| FaxNumber: | 9199420038 | ||||||||
| Practice Location | |||||||||
| Address1: | 1728 FORDHAM BLVD | ||||||||
| Address2: | 151 RAMS PLAZA | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275142397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199681985 | ||||||||
| FaxNumber: | 9199420038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 79098 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | MP011213 | 01 | NC | NC MEDICAL BOARD REGISTRA | OTHER |