Healthcare Provider Details

I. General information

NPI: 1568304954
Provider Name (Legal Business Name): JYMIRA LEE WILLIAMS CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 GEOFFRY LN APT C
SAINT LOUIS MO
63132-4617
US

IV. Provider business mailing address

664 GEOFFRY LN APT C
SAINT LOUIS MO
63132-4617
US

V. Phone/Fax

Practice location:
  • Phone: 314-504-3469
  • Fax:
Mailing address:
  • Phone: 314-504-3469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberMO025850201890
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: