Provider Demographics
NPI:1083225577
Name:WILLIAMS, KELLY (MS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9425 LAKE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-2725
Mailing Address - Country:US
Mailing Address - Phone:443-257-6868
Mailing Address - Fax:
Practice Address - Street 1:6508 DEER POINTE DR STE 4C
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1668
Practice Address - Country:US
Practice Address - Phone:410-742-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist