Provider Demographics
NPI:1306245238
Name:POWELL, KARLY (ND)
Entity type:Individual
Prefix:
First Name:KARLY
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E LAS ANIMAS ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-4138
Mailing Address - Country:US
Mailing Address - Phone:719-551-5282
Mailing Address - Fax:719-639-2054
Practice Address - Street 1:128 E LAS ANIMAS ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4138
Practice Address - Country:US
Practice Address - Phone:719-551-5282
Practice Address - Fax:719-639-2054
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1999175F00000X
COND.0000084175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath