Healthcare Provider Details

I. General information

NPI: 1932748746
Provider Name (Legal Business Name): KHALILAH WILLIAMS-PERRY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ALBANY POST RD
MONTGOMERY NY
12549-2132
US

IV. Provider business mailing address

707 E MAIN ST
MIDDLETOWN NY
10940-2650
US

V. Phone/Fax

Practice location:
  • Phone: 845-457-3155
  • Fax: 845-457-9036
Mailing address:
  • Phone: 845-333-7575
  • Fax: 845-333-7139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344735
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: