Healthcare Provider Details

I. General information

NPI: 1407790488
Provider Name (Legal Business Name): CARLISHA MARIE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 6TH AVE
KINDER LA
70648-3187
US

IV. Provider business mailing address

108 6TH AVE
KINDER LA
70648-3187
US

V. Phone/Fax

Practice location:
  • Phone: 337-738-9494
  • Fax: 337-738-9449
Mailing address:
  • Phone: 337-738-9494
  • Fax: 337-738-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number244085
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: