Healthcare Provider Details

I. General information

NPI: 1780955997
Provider Name (Legal Business Name): KIM B. POWERS, D.O., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 66TH ST N STE 206
PINELLAS PARK FL
33781-2101
US

IV. Provider business mailing address

7800 66TH ST N STE 206
PINELLAS PARK FL
33781-2101
US

V. Phone/Fax

Practice location:
  • Phone: 727-541-0323
  • Fax: 727-541-0336
Mailing address:
  • Phone: 727-541-0323
  • Fax: 727-541-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS6697
License Number StateFL

VIII. Authorized Official

Name: KIM BARTHOLOMEW POWERS
Title or Position: OWNER
Credential: D.O.
Phone: 727-541-0323