Healthcare Provider Details

I. General information

NPI: 1629857560
Provider Name (Legal Business Name): DEBORAH KAY WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 TANGLEWOOD DR
MOUNT HOPE WV
25880-9501
US

IV. Provider business mailing address

210 TANGLEWOOD DR
MOUNT HOPE WV
25880-9501
US

V. Phone/Fax

Practice location:
  • Phone: 304-811-3642
  • Fax:
Mailing address:
  • Phone: 304-811-3642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: