Provider Demographics
NPI:1043774862
Name:WILLIAMS, KRYSTAL J
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 KILPATRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5166
Mailing Address - Country:US
Mailing Address - Phone:318-381-8584
Mailing Address - Fax:877-819-9001
Practice Address - Street 1:3000 KILPATRICK BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5166
Practice Address - Country:US
Practice Address - Phone:318-381-8584
Practice Address - Fax:877-819-9001
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator