Healthcare Provider Details

I. General information

NPI: 1871439158
Provider Name (Legal Business Name): KELSIE MARILYN WILLIAMS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HENNESSY BLVD
BATON ROUGE LA
70808-4375
US

IV. Provider business mailing address

156 JORDAN CT
LA PLACE LA
70068-5802
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-6565
  • Fax:
Mailing address:
  • Phone: 985-817-5075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: