Individual
KODI D POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
109 S WILLOW ST, PAULS VALLEY, OK 73075-3833
(405) 238-7311
Mailing address
PO BOX 189, ARDMORE, OK 73402-0189
(580) 319-7305
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/16/2021
Last updated
07/03/2024
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