Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | NM1319 | CA |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 201800946NP-PP | OR |
NPI | 1104126861 |
---|---|
Provider Name | Kimberly Jean Powell |
First Address | Corvallis, OR 97330-3745 |
Second Address | Corvallis, OR 97330-3745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2010 |
Last Update Date | 04/04/2018 |