Healthcare Provider Details

I. General information

NPI: 1487008751
Provider Name (Legal Business Name): KIYANNA MARIE WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42600 MIRAGE RD
RANCHO MIRAGE CA
92270-4127
US

IV. Provider business mailing address

9900 N CENTRAL EXPY STE 500
DALLAS TX
75231-0928
US

V. Phone/Fax

Practice location:
  • Phone: 760-423-4000
  • Fax:
Mailing address:
  • Phone: 214-987-3376
  • Fax: 469-532-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number203773
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01092905A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number01092905A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number203773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: