Provider Demographics
NPI:1447624333
Name:POWERS, HOLLY A (CNP)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:A
Last Name:POWERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 N WHITE SANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6926
Mailing Address - Country:US
Mailing Address - Phone:575-434-0180
Mailing Address - Fax:575-434-0181
Practice Address - Street 1:916 N WHITE SANDS BLVD
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6926
Practice Address - Country:US
Practice Address - Phone:575-434-0180
Practice Address - Fax:575-434-0181
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02803363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM57802726Medicaid
NM465160YY54Medicare PIN