Individual
KELLI POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
215 MAYNARD LAKE RD, ERWIN, NC 28339-8507
(910) 897-8121
Mailing address
215 MAYNARD LAKE RD, ERWIN, NC 28339-8507
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
LAT-2780
NC
Other
Enumeration date
09/19/2016
Last updated
09/19/2016
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