Basic Information
| Provider Information | |||||||||
| NPI: | 1720406713 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | ALEC | ||||||||
| MiddleName: | J'DAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1320 S. SOLANO | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 88001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755277900 | ||||||||
| FaxNumber: | 5755714872 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 S. HUDSON STE #6 | ||||||||
| Address2: | |||||||||
| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 88061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753884412 | ||||||||
| FaxNumber: | 5755341170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2014 | ||||||||
| LastUpdateDate: | 04/07/2014 | ||||||||
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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 | 163WA0400X | RN-78019 | NM | Y | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 18677037 | 05 | NM | MEDICAID |