Healthcare Provider Details

I. General information

NPI: 1336837764
Provider Name (Legal Business Name): ARICA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 BROADWAY BLVD
KANSAS CITY MO
64111-2506
US

IV. Provider business mailing address

3722 BROADWAY BLVD
KANSAS CITY MO
64111-2506
US

V. Phone/Fax

Practice location:
  • Phone: 888-435-8882
  • Fax:
Mailing address:
  • Phone: 888-435-8882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number2009035079
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: