MEDICARE: KYLA WILLIAMSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1023232402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLA WILLIAMSON

Provider Business Mailing Address
First Line	:	4140 N CENTRAL AVE
Second Line	:	APT. 3138
City	:	PHOENIX
State	:	AZ
Zip	:	85012-1830
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 E CAMELBACK RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4710
Country	:	US
Telephone Number	:	602-840-4400
Fax Number	:	602-840-0490

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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Directions to “ KYLA WILLIAMSON ” Practice Location

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