Provider Demographics
NPI:1043511421
Name:AUSTIN-WILLIAMS, KENZIE D (LMP)
Entity Type:Individual
Prefix:
First Name:KENZIE
Middle Name:D
Last Name:AUSTIN-WILLIAMS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 46TH AVE E
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-1205
Mailing Address - Country:US
Mailing Address - Phone:425-780-9282
Mailing Address - Fax:
Practice Address - Street 1:16515 MERIDIAN E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6251
Practice Address - Country:US
Practice Address - Phone:253-209-8535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60019931172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker