Individual
DR. KIMBERLY NICHOLE POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
415 N 9TH ST, SUITE 4W16, SPRINGFIELD, IL 62702-5303
(217) 545-8000
(217) 757-6654
Mailing address
PO BOX 19635, SPRINGFIELD, IL 62794-9635
(217) 545-8000
(217) 757-6654
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2011009284
MO
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
036140805
IL
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
2011009284
MO
Other
Enumeration date
08/04/2008
Last updated
08/01/2016
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