Provider Demographics
NPI:1841776721
Name:POWELL, THELMA LAKAY
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:LAKAY
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 1:1425 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-2303
Mailing Address - Country:US
Mailing Address - Phone:850-694-2604
Mailing Address - Fax:
Practice Address - Street 1:1425 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-2303
Practice Address - Country:US
Practice Address - Phone:850-694-2604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion