Healthcare Provider Details

I. General information

NPI: 1932646718
Provider Name (Legal Business Name): KIERRA WILLIAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 05/27/2021
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 STEPHANIE LN
AKRON OH
44306-4525
US

IV. Provider business mailing address

1844 STEPHANIE LN
AKRON OH
44306-4525
US

V. Phone/Fax

Practice location:
  • Phone: 330-962-3411
  • Fax:
Mailing address:
  • Phone: 330-962-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number178790
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: