Healthcare Provider Details

I. General information

NPI: 1093193070
Provider Name (Legal Business Name): TAKEIRA WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAKEIRA WILLIAMS RN

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 08/31/2024
Certification Date: 08/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S MERAMEC AVE STE 300
CLAYTON MO
63105-3514
US

IV. Provider business mailing address

720 OLIVE ST APT 2104
SAINT LOUIS MO
63101-2302
US

V. Phone/Fax

Practice location:
  • Phone: 877-220-3434
  • Fax:
Mailing address:
  • Phone: 314-399-8622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number2013039396
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2013039396
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2013039396
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: