1174581425 NPI number — KAY M POWELL NP

Table of content: KAY M POWELL NP (NPI 1174581425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174581425 NPI number — KAY M POWELL NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWELL
Provider First Name:
KAY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SNAPP
Provider Other First Name:
KAY
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174581425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
98 POPLAR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLACKFOOT
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83221-1758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-782-3700
Provider Business Mailing Address Fax Number:
208-782-3994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 AIRPORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLACKFOOT
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83221-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-782-3979
Provider Business Practice Location Address Fax Number:
208-782-3994
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  NP-343A , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NPYU4 . This is a "BLUE CROSS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: NPX02 . This is a "BLUE CROSS OLD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 270387 . This is a "ALTIUS OLD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 313074 . This is a "ALTIUS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010153632 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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