Provider Demographics
NPI:1215700844
Name:POWERS, MEREDITH LEE
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:LEE
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 1:5833 N MILLSBORO CIR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67219-1668
Mailing Address - Country:US
Mailing Address - Phone:785-217-6693
Mailing Address - Fax:
Practice Address - Street 1:5833 N MILLSBORO CIR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:KS
Practice Address - Zip Code:67219-1668
Practice Address - Country:US
Practice Address - Phone:785-217-6693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program