Provider Demographics
NPI:1073197927
Name:POWELL, KIMBERLY FAYE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FAYE
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 1:838 COBURN ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1459
Mailing Address - Country:US
Mailing Address - Phone:330-434-4141
Mailing Address - Fax:
Practice Address - Street 1:838 COBURN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1459
Practice Address - Country:US
Practice Address - Phone:330-434-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker