MEDICARE: KENDRA LATOYA WILLIAMS

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	253Z00000X	In Home Supportive Care Agency	IHCP-1628	SC

General Provider Information

NPI Number	:	1033849112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA LATOYA WILLIAMS

Provider Business Mailing Address
First Line	:	919 TRUE ST STE B3
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1662
Country	:	US
Telephone Number	:	803-586-9243
Fax Number	:

Provider Business Practice Location Address
First Line	:	919 TRUE ST STE B3
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1662
Country	:	US
Telephone Number	:	803-586-9243
Fax Number	:

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

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	06/13/2022

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