MEDICARE: KENYATTA 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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1174146286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENYATTA WILLIAMS

Provider Business Mailing Address
First Line	:	8725 COUNTRY VIEW AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7675
Country	:	US
Telephone Number	:	702-427-6272
Fax Number	:	702-931-9274

Provider Business Practice Location Address
First Line	:	2455 W CHEYENNE AVE STE 110
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-4326
Country	:	US
Telephone Number	:	702-931-1003
Fax Number	:	703-931-9274

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

Provider Enumeration Date	:	05/22/2020
Last Update Date	:	06/06/2026

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Directions to “ KENYATTA WILLIAMS ” Practice Location

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