Healthcare Provider Details

I. General information

NPI: 1790518694
Provider Name (Legal Business Name): KENDRA WILLIAMS IBCLC, DIPL. OM, CBD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4049 PENNSYLVANIA AVE STE 203 #296
KANSAS CITY MO
64111
US

IV. Provider business mailing address

4049 PENNSYLVANIA AVE STE 203 #296
KANSAS CITY MO
64111
US

V. Phone/Fax

Practice location:
  • Phone: 816-827-0316
  • Fax:
Mailing address:
  • Phone: 816-827-0316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-314962
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: