Healthcare Provider Details

I. General information

NPI: 1346175957
Provider Name (Legal Business Name): ANDREA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 MADRONA ST N # 900C
TWIN FALLS ID
83301-8318
US

IV. Provider business mailing address

3215 N 3470 E
KIMBERLY ID
83341-5364
US

V. Phone/Fax

Practice location:
  • Phone: 208-961-1890
  • Fax:
Mailing address:
  • Phone: 208-961-1890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAS-3786
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: