Provider Demographics
NPI:1073854832
Name:WILLIAMS, KRISTA LOU
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:LOU
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 1:1200 PEACHTREE LN
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7008
Mailing Address - Country:US
Mailing Address - Phone:270-535-3958
Mailing Address - Fax:270-746-2275
Practice Address - Street 1:1200 PEACHTREE LN
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7008
Practice Address - Country:US
Practice Address - Phone:270-535-3958
Practice Address - Fax:270-746-2275
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000064294222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist