Healthcare Provider Details

I. General information

NPI: 1922667351
Provider Name (Legal Business Name): KENYETTA VEREEN POWELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W MAIN ST
MONCKS CORNER SC
29461-2673
US

IV. Provider business mailing address

109 W MAIN ST
MONCKS CORNER SC
29461-2673
US

V. Phone/Fax

Practice location:
  • Phone: 843-214-9315
  • Fax:
Mailing address:
  • Phone: 843-214-9315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number101943
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number101943
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: