Provider Demographics
NPI:1093404865
Name:WILLIAMS, KENNY RAY
Entity Type:Individual
Prefix:MR
First Name:KENNY
Middle Name:RAY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-0175
Mailing Address - Country:US
Mailing Address - Phone:580-331-2370
Mailing Address - Fax:405-422-8282
Practice Address - Street 1:10320 N AIRPORT RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-7530
Practice Address - Country:US
Practice Address - Phone:580-331-2370
Practice Address - Fax:405-422-8282
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist