Provider Demographics
NPI:1750957577
Name:POWELL, FREEDOM DAWN (BS)
Entity type:Individual
Prefix:
First Name:FREEDOM
Middle Name:DAWN
Last Name:POWELL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:FREEDOM
Other - Middle Name:DAWN
Other - Last Name:OTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:411 GIBSON LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2577
Mailing Address - Country:US
Mailing Address - Phone:859-623-9367
Mailing Address - Fax:
Practice Address - Street 1:411 GIBSON LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2577
Practice Address - Country:US
Practice Address - Phone:859-623-9367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator