Provider Demographics
NPI:1114545332
Name:POWELL-JONES, KIZZY
Entity Type:Individual
Prefix:
First Name:KIZZY
Middle Name:
Last Name:POWELL-JONES
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 1:509 W 36TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-3107
Mailing Address - Country:US
Mailing Address - Phone:757-752-2185
Mailing Address - Fax:
Practice Address - Street 1:509 W 36TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-3107
Practice Address - Country:US
Practice Address - Phone:757-752-2185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide