Provider Demographics
NPI:1891760955
Name:POWELL, KERRI LYNETTE (MD)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:LYNETTE
Last Name:POWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:430 MORRIS AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-3609
Mailing Address - Country:US
Mailing Address - Phone:908-868-5845
Mailing Address - Fax:908-353-0727
Practice Address - Street 1:430 MORRIS AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3609
Practice Address - Country:US
Practice Address - Phone:908-353-5437
Practice Address - Fax:908-353-0727
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA69704208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics