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General NPI Number Information
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NPI Number | 1891760955
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Entity Type | Individual
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Provider Name | KERRI LYNETTE POWELL MD
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Gender | Female
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 430 MORRIS AVE 1ST FLOOR
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City | ELIZABETH
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State | NJ
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Zip | 07208-3609
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Country | US
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Telephone | 908-353-5437
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Fax | 908-353-0727
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Provider Business Mailing Address
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Address Line | 430 MORRIS AVE 1ST FLOOR
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City | ELIZABETH
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State | NJ
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Zip | 07208-3609
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Country | US
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Telephone | 908-868-5845
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Fax | 908-353-0727
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MA69704
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License Number State | NJ
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