Provider Demographics
NPI:1003937418
Name:POWELL, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
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 1:29796 272ND RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:KS
Mailing Address - Zip Code:67038-9076
Mailing Address - Country:US
Mailing Address - Phone:620-876-3227
Mailing Address - Fax:620-876-3233
Practice Address - Street 1:29796 272ND RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:KS
Practice Address - Zip Code:67038-9076
Practice Address - Country:US
Practice Address - Phone:620-876-3227
Practice Address - Fax:620-876-3233
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator