Provider Demographics
NPI:1720285505
Name:POWELL, KIMBERLY DAWN
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:POWELL
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 1:1749 HEWITT RD
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:OK
Mailing Address - Zip Code:73463-1875
Mailing Address - Country:US
Mailing Address - Phone:580-490-9750
Mailing Address - Fax:
Practice Address - Street 1:1749 HEWITT RD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:OK
Practice Address - Zip Code:73463-1875
Practice Address - Country:US
Practice Address - Phone:580-490-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health