Healthcare Provider Details

I. General information

NPI: 1144694548
Provider Name (Legal Business Name): CHRISTINA WILLIAMS CA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 W 39TH ST # 160
KANSAS CITY MO
64111-7016
US

IV. Provider business mailing address

809 W 39TH ST # 160
KANSAS CITY MO
64111-7016
US

V. Phone/Fax

Practice location:
  • Phone: 657-205-7674
  • Fax:
Mailing address:
  • Phone: 657-205-7674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: