Jacob Lee Powell

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT777 Issued in ME

Practice address

925 Union St Ste 3
Bangor, ME 04401-3051

Phone

(207) 973-8839

NPI assigned

Jul 13, 2020

Last updated

Jul 13, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594598400000",
    "number": "1710505144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 UNION ST STE 3",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013051",
            "telephone_number": "207-973-8839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 UNION ST STE 3",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013051",
            "telephone_number": "207-973-8839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWELL",
        "first_name": "JACOB",
        "middle_name": "LEE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-07-13",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ME",
            "license": "AT777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Markos Poulopoulos, M.D.
• Pouzol Physical Therapy, PA
• Philip R Pouzol, PT
• Stephanie Pouzol, DMD
• Gloria J Powell, MA
• Savanna Rae Power
• Annie E Powers, MD
• Kari Powers, CRNA
• Praveen Pavuluru, DMD, LLC (Carefirst Dental Clinic)
• Premier Medical Services

• Athletic Trainer in Bangor, ME
• Providers in Bangor, ME by specialty
• Athletic Trainer in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.