Provider Demographics
NPI:1831334382
Name:POWELL, KEITH A
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:POWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75106-0425
Mailing Address - Country:US
Mailing Address - Phone:972-224-4015
Mailing Address - Fax:972-224-4339
Practice Address - Street 1:1472 N. HAMPTON ROAD SUITE 111
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3033
Practice Address - Country:US
Practice Address - Phone:972-224-4015
Practice Address - Fax:972-224-4339
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance