Active NPI
Derwin Powell, RN
- Registered Nurse
- Kennesaw, GA
National Provider Identifier
1356096382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 203006
- Practice address
- 2100 Shiloh Valley Dr NW Apt 1323
Kennesaw, GA 30144-3179 - Phone
- (931) 216-8092
- NPI assigned
- Feb 17, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 203006 | GA | Primary |
Addresses
Primary practice location
2100 Shiloh Valley Dr NW Apt 1323
Kennesaw, GA 30144-3179
Mailing address
2100 Shiloh Valley Dr NW Apt 1323
Kennesaw, GA 30144-3179
Phone (931) 216-8092
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 203006 | GA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1645056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645056000000",
"number": "1356096382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 SHILOH VALLEY DR NW APT 1323",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301443179",
"telephone_number": "931-216-8092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 SHILOH VALLEY DR NW APT 1323",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301443179",
"telephone_number": "931-216-8092"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POWELL",
"first_name": "DERWIN",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-02-17",
"last_updated": "2022-02-17",
"certification_date": "2022-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "GA",
"license": "203006",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.