Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | D5720 | AL |
NPI | 1588899678 |
---|---|
Provider Name | Kathlyn Kruger Powell |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35244-1900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2009 |
Last Update Date | 02/09/2016 |