Healthcare Provider Details

I. General information

NPI: 1629909783
Provider Name (Legal Business Name): TYNIECE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5023 E 56TH ST STE 305
LAWRENCE IN
46226-1471
US

IV. Provider business mailing address

5023 E 56TH ST STE 305
LAWRENCE IN
46226-1471
US

V. Phone/Fax

Practice location:
  • Phone: 317-498-7017
  • Fax: 463-210-1113
Mailing address:
  • Phone: 317-498-7017
  • Fax: 463-210-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: