Provider Demographics
NPI:1376130757
Name:POWERS THREATT, KIMBERLEY (CPT, TPW)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:POWERS THREATT
Suffix:
Gender:F
Credentials:CPT, TPW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2393 PLUM ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-3223
Mailing Address - Country:US
Mailing Address - Phone:614-260-5787
Mailing Address - Fax:
Practice Address - Street 1:2393 PLUM ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-3223
Practice Address - Country:US
Practice Address - Phone:614-260-5787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care