MEDICARE: TIAERA DENISE 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	:	1427940113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIAERA DENISE WILLIAMS

Provider Business Mailing Address
First Line	:	4280 ESCONDIDO ST APT 221
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5759
Country	:	US
Telephone Number	:	702-695-2558
Fax Number	:

Provider Business Practice Location Address
First Line	:	4280 ESCONDIDO ST APT 221
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5759
Country	:	US
Telephone Number	:	702-695-2558
Fax Number	:

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

Provider Enumeration Date	:	07/17/2025
Last Update Date	:	07/17/2025

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Directions to “ TIAERA DENISE WILLIAMS ” Practice Location

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