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NPI Code Detail

MEDICARE: MRS. KELLY JO POWELL PA-C

MEDICARE: MRS. KELLY JO POWELL PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA942KY

General Provider Information

NPI Number : 1477504595
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY JO POWELL PA-C
Provider Business Mailing Address
First Line : 1221 S BROADWAY
Second Line :
City : LEXINGTON
State : KY
Zip : 40504-2701
Country : US
Telephone Number : 859-258-6200
Fax Number : 859-258-6203
Provider Business Practice Location Address
First Line : 3085 LAKECREST CIR
Second Line :
City : LEXINGTON
State : KY
Zip : 40513-1707
Country : US
Telephone Number : 859-258-8600
Fax Number : 859-258-8610
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2006
Last Update Date : 03/10/2022

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Directions to “ MRS. KELLY JO POWELL PA-C” Practice Location

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