Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD48720 | TN |
N | 207X00000X | Orthopaedic Surgeon | T-1987 | MS |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 23488 | MS |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 320573 | LA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | P7970 | TX |
NPI | 1285833129 |
---|---|
Provider Name | Kenneth Patrick Powell |
First Address | Shreveport, LA 71103-4239 |
Second Address | Shreveport, LA 71103-4239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 06/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08129884 | (05) | MS |