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General NPI Number Information
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NPI Number | 1336863901
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Entity Type | Individual
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Provider Name | KEISHA WILLIAMS
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Gender | Female
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 11901 PLEASANT RIDGE RD APT 223
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City | LITTLE ROCK
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State | AR
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Zip | 72223-2513
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Country | US
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Telephone | 501-291-2008
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21471
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City | LITTLE ROCK
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State | AR
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Zip | 72221-1471
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Country | US
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Telephone | 501-291-2008
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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