Healthcare Provider Details

I. General information

NPI: 1053231688
Provider Name (Legal Business Name): ANDREA LYNN WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 N REECE ST
GODDARD KS
67052-1100
US

IV. Provider business mailing address

1913 N REECE ST
GODDARD KS
67052-1100
US

V. Phone/Fax

Practice location:
  • Phone: 316-641-4388
  • Fax:
Mailing address:
  • Phone: 316-641-4388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-105524-042
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: