Healthcare Provider Details

I. General information

NPI: 1891707642
Provider Name (Legal Business Name): WILLIAM POWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 OLD SYMSONIA RD
BENTON KY
42025-5094
US

IV. Provider business mailing address

PO BOX 526
BENTON KY
42025-0526
US

V. Phone/Fax

Practice location:
  • Phone: 270-527-2411
  • Fax: 270-527-8734
Mailing address:
  • Phone: 270-527-2411
  • Fax: 270-527-8734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34554
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: