Provider Demographics
NPI:1730492570
Name:POWERS, KIRK A (PA)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:A
Last Name:POWERS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:164 WETHERBY LN STE B
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4957
Mailing Address - Country:US
Mailing Address - Phone:614-939-2308
Mailing Address - Fax:614-939-2309
Practice Address - Street 1:615 COPELAND MILL RD STE 2D
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8904
Practice Address - Country:US
Practice Address - Phone:614-939-2308
Practice Address - Fax:614-939-2309
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002993363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50.002993RXOtherSTATE OF OHIO MEDICAL BOARD