Healthcare Provider Details

I. General information

NPI: 1598363194
Provider Name (Legal Business Name): NAKIA KEISHANEE WILLIAMS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 GREENSPRING DR STE G8
TIMONIUM MD
21093-4137
US

IV. Provider business mailing address

315 LYNNE DR
MOUNT WOLF PA
17347-9597
US

V. Phone/Fax

Practice location:
  • Phone: 410-999-0114
  • Fax:
Mailing address:
  • Phone: 410-917-6795
  • Fax: 717-782-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP022254
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR163942
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: