Healthcare Provider Details

I. General information

NPI: 1063031227
Provider Name (Legal Business Name): KENYALL SHARDAE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9244 FLORIDA BLVD STE E
BATON ROUGE LA
70815-1160
US

IV. Provider business mailing address

9244 FLORIDA BLVD STE E
BATON ROUGE LA
70815-1160
US

V. Phone/Fax

Practice location:
  • Phone: 225-806-9503
  • Fax:
Mailing address:
  • Phone: 225-806-9503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: