MEDICARE: KIMBERLY POWELL

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
1	374U00000X	Home Health Aide
2	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1528838885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY POWELL

Provider Business Mailing Address
First Line	:	3825 E 53RD ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-3317
Country	:	US
Telephone Number	:	216-202-5081
Fax Number	:	216-591-0118

Provider Business Practice Location Address
First Line	:	3825 E 53RD ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-3317
Country	:	US
Telephone Number	:	216-202-5081
Fax Number	:	216-591-0118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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Directions to “ KIMBERLY POWELL ” Practice Location

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