Healthcare Provider Details

I. General information

NPI: 1336863901
Provider Name (Legal Business Name): KEISHA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 PLEASANT RIDGE RD APT 223
LITTLE ROCK AR
72223-2513
US

IV. Provider business mailing address

PO BOX 21471
LITTLE ROCK AR
72221-1471
US

V. Phone/Fax

Practice location:
  • Phone: 501-291-2008
  • Fax:
Mailing address:
  • Phone: 501-291-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: