Provider Demographics
NPI:1881820223
Name:POWELL, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
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 1:4128 W AVENUE L
Mailing Address - Street 2:APT. C
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4259
Mailing Address - Country:US
Mailing Address - Phone:661-206-5789
Mailing Address - Fax:
Practice Address - Street 1:1609 E PALMDALE BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4881
Practice Address - Country:US
Practice Address - Phone:661-947-1595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator