Provider Demographics
NPI:1700039146
Name:POWELL, KATHY
Entity Type:Individual
Prefix:MISS
First Name:KATHY
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 1:722 W. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CLARKSON
Mailing Address - State:KY
Mailing Address - Zip Code:42726
Mailing Address - Country:US
Mailing Address - Phone:270-200-2100
Mailing Address - Fax:270-200-2101
Practice Address - Street 1:722 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLARKSON
Practice Address - State:KY
Practice Address - Zip Code:42726
Practice Address - Country:US
Practice Address - Phone:270-200-2100
Practice Address - Fax:270-200-2101
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies