Healthcare Provider Details

I. General information

NPI: 1568307312
Provider Name (Legal Business Name): LASHANDA CHARLENE BLUE-WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 CLEAR CREEK RD STE 101
KILLEEN TX
76549-4344
US

IV. Provider business mailing address

1401 EXCEL DR
KILLEEN TX
76542-6313
US

V. Phone/Fax

Practice location:
  • Phone: 254-200-3200
  • Fax:
Mailing address:
  • Phone: 254-768-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1233624
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: