Healthcare Provider Details

I. General information

NPI: 1013777481
Provider Name (Legal Business Name): KELLY WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18645 GREENWELL SPRINGS RD APT 3
GREENWELL SPRINGS LA
70739-4841
US

IV. Provider business mailing address

8713 LOCH FYNE AVE
BAKER LA
70714-7039
US

V. Phone/Fax

Practice location:
  • Phone: 225-235-7509
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number30001492
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-309153
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: