Individual
KEYARRA POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6164 COOLIDGE ST, DEARBORN HEIGHTS, MI 48127-2863
(313) 588-1350
Mailing address
6164 COOLIDGE ST, DEARBORN HEIGHTS, MI 48127-2863
(313) 588-1350
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123456
DO NOT HAVE THE NUMBERS
MI
Enumeration date
10/12/2020
Last updated
10/12/2020
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