Provider Demographics
NPI:1376961409
Name:POWELL, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 S 6TH ST
Mailing Address - Street 2:FLOOR 2, SUITE F275
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454
Mailing Address - Country:US
Mailing Address - Phone:612-625-3330
Mailing Address - Fax:612-273-9774
Practice Address - Street 1:2450 RIVERSIDE AVE # F275
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-273-8700
Practice Address - Fax:612-273-8727
Is Sole Proprietor?:No
Enumeration Date:2014-04-05
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-052132084P0800X
NM390200000X
MN745012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program