MEDICARE: KEYONNA 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		DC

General Provider Information

NPI Number	:	1801438205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYONNA WILLIAMS

Provider Business Mailing Address
First Line	:	2518 17TH ST NW APT 408
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-2862
Country	:	US
Telephone Number	:	240-660-8338
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 7TH ST NW APT 421
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20001-3517
Country	:	US
Telephone Number	:	202-332-5196
Fax Number	:

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

Provider Enumeration Date	:	10/17/2019
Last Update Date	:	10/17/2019

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