Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2011009284 | MO |
Y | 2080P0203X | Pediatric Critical Care Doctor | 036140805 | IL |
N | 2080P0204X | Pediatric Emergency Doctor | 2011009284 | MO |
NPI | 1033375605 |
---|---|
Provider Name | Dr. Kimberly Nichole Powell |
First Address | Springfield, IL 62794-9635 |
Second Address | Springfield, IL 62702-5303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2008 |
Last Update Date | 01/08/2016 |