Healthcare Provider Details

I. General information

NPI: 1457287716
Provider Name (Legal Business Name): KENYA ANTOINETTE POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2623 PARKSIDE TER
BROOKHAVEN PA
19015-4908
US

IV. Provider business mailing address

2623 PARKSIDE TER
BROOKHAVEN PA
19015-4908
US

V. Phone/Fax

Practice location:
  • Phone: 484-843-6095
  • Fax:
Mailing address:
  • Phone: 610-800-0899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number19688
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: