Healthcare Provider Details

I. General information

NPI: 1447556428
Provider Name (Legal Business Name): MS. DEVONDA KATHERINE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 WALLER AVE STE 201
LEXINGTON KY
40504-2918
US

IV. Provider business mailing address

343 WALLER AVE STE 201
LEXINGTON KY
40504-2918
US

V. Phone/Fax

Practice location:
  • Phone: 859-271-9448
  • Fax:
Mailing address:
  • Phone: 859-271-9448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: