Healthcare Provider Details

I. General information

NPI: 1578060745
Provider Name (Legal Business Name): KELISHIA LENETTE WILLIAMS-NELSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13450 INWOOD RD STE 400
DALLAS TX
75244-5329
US

IV. Provider business mailing address

13450 INWOOD RD STE 400
DALLAS TX
75244-5329
US

V. Phone/Fax

Practice location:
  • Phone: 469-245-3564
  • Fax: 469-293-1102
Mailing address:
  • Phone: 469-245-3564
  • Fax: 469-293-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number808979
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number808979
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: