Provider Demographics
NPI:1447865175
Name:POWERS, SHELIA RENEE
Entity type:Individual
Prefix:MRS
First Name:SHELIA
Middle Name:RENEE
Last Name:POWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 JACKSON CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1261
Mailing Address - Country:US
Mailing Address - Phone:662-251-5307
Mailing Address - Fax:
Practice Address - Street 1:403 JACKSON CIR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1261
Practice Address - Country:US
Practice Address - Phone:662-251-5307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR872457390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program