Healthcare Provider Details

I. General information

NPI: 1124793161
Provider Name (Legal Business Name): REBECCA KAY WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 09/11/2025
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 GROSS AVENUE
BURNSVILLE MS
38833-9702
US

IV. Provider business mailing address

26 GROSS AVENUE
BURNSVILLE MS
38833-9702
US

V. Phone/Fax

Practice location:
  • Phone: 662-424-2812
  • Fax:
Mailing address:
  • Phone: 662-424-2812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR869847
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: