Provider Demographics
NPI:1760920938
Name:POWELL, KIRA JILL (MED)
Entity Type:Individual
Prefix:
First Name:KIRA JILL
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 AVANT AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3916
Mailing Address - Country:US
Mailing Address - Phone:580-323-3322
Mailing Address - Fax:580-323-6233
Practice Address - Street 1:600 AVANT AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3916
Practice Address - Country:US
Practice Address - Phone:580-323-3322
Practice Address - Fax:580-323-6233
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor