Provider Demographics
NPI:1437573359
Name:POWELL, KYRA (CRNP)
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 HIGHWAY 33 UNIT A
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-4887
Mailing Address - Country:US
Mailing Address - Phone:205-222-3383
Mailing Address - Fax:
Practice Address - Street 1:1940 HIGHWAY 33 UNIT A
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-4887
Practice Address - Country:US
Practice Address - Phone:205-664-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-118530363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health