Basic Information
| Provider Information | |||||||||
| NPI: | 1588916142 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PA C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13579 | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196123579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846280799 | ||||||||
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| Practice Location | |||||||||
| Address1: | 420 S 5TH AVE | ||||||||
| Address2: | |||||||||
| City: | WEST READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196112143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846283637 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2012 | ||||||||
| LastUpdateDate: | 05/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA055766 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.