Healthcare Provider Details

I. General information

NPI: 1427997790
Provider Name (Legal Business Name): KALECIA WILLIAMS BSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 QUEEN ELEANOR LN
JACKSON MS
39209-2223
US

IV. Provider business mailing address

5350 QUEEN ELEANOR LN
JACKSON MS
39209-2223
US

V. Phone/Fax

Practice location:
  • Phone: 251-257-9550
  • Fax:
Mailing address:
  • Phone: 251-257-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberEP-AGENCY
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: