Provider Demographics
NPI:1831457373
Name:POWER, KENNETH HOLDEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:HOLDEN
Last Name:POWER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 N LIDGERWOOD ST STE 126
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-1122
Mailing Address - Country:US
Mailing Address - Phone:509-434-1990
Mailing Address - Fax:
Practice Address - Street 1:5901 N LIDGERWOOD ST STE 126
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1122
Practice Address - Country:US
Practice Address - Phone:509-434-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61395636207Q00000X
IN01073534A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD61395636OtherMEDICAL LICENSE
IN01073534AOtherMEDICAL LICENSE
CODR.0066180OtherMEDICAL LICENSE