Basic Information
| Provider Information | |||||||||
| NPI: | 1104126861 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 444 NW ELKS DR | ||||||||
| Address2: | |||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973303745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417541150 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 444 NW ELKS DR | ||||||||
| Address2: | |||||||||
| City: | CORVALLIS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973303745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417541150 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2010 | ||||||||
| LastUpdateDate: | 04/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WW0101X | 8399023-4405 | UT | N | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory | 163WW0101X | NP2618 | CA | N | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory | 176B00000X | NM1319 | CA | N | Other Service Providers | Midwife | 367A00000X | 201406025NP-PP | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | 8399023-4402 | UT | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363LW0102X | 201800946NP-PP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.