Provider Demographics
NPI:1861692774
Name:POWERS, KATHLEEN MARY (APN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARY
Last Name:POWERS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:148 BLUEJACKET AVE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2421
Mailing Address - Country:US
Mailing Address - Phone:609-597-7011
Mailing Address - Fax:
Practice Address - Street 1:44 NAUTILUS DRIVE
Practice Address - Street 2:BARNEGAT MEDICAL ASSOCIATES
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050
Practice Address - Country:US
Practice Address - Phone:609-978-0474
Practice Address - Fax:609-597-6186
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00137800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health