Healthcare Provider Details

I. General information

NPI: 1902509532
Provider Name (Legal Business Name): TAKONIA LYNN WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10119 TEAYS VALLEY RD
SCOTT DEPOT WV
25560-7491
US

IV. Provider business mailing address

10119 TEAYS VALLEY RD
SCOTT DEPOT WV
25560-7491
US

V. Phone/Fax

Practice location:
  • Phone: 304-419-1574
  • Fax:
Mailing address:
  • Phone: 304-419-1574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number96170
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: